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HEALTH  SCIENCES 
LIBRARY 


\   ^  r 


MAN  AND  HIS  MALADIES 


OR 


THE  WAY  TO  HEALTH 


A  POPULAR  HANDBOOK  OF 

PHYSIOLOGY  AND  DOMESTIC  MEDICINE  IN  ACCOED  WITH 
THE  ADVANCE  IN  MEDICAL  SCIENCE 


By   a.  E.  BKIDGEE 

B.A.,  M.D.,  B.Sc,  F.ILC.P.E. 

AUTHOR  OF  "the  DEMON  OF  DYSPEPSIA"  "BILIOUSNESS"   "'DIET  IN  EPILEPSY' 
"  EPITOME  OF  TWO  HUNDRED  CASES  OF  TYPHOID  FETER  "  ETC. 


NEW    YORK 
HARPER  &  BROTHERS,  FRANKLIN  SQUARE 

1889 


KCSI 

'374 


PREFACE. 


It  has  been  said  that  in  every  human  heart  there  exists 
a  recess,  called  by  the  French  le  petit  coin  bleu,  where, 
safe  from  the  besoms  of  reason  and  of  logic,  lie  hid  many 
un avowed  beliefs. 

Thus,  that  medicine  is  a  science  to  be  studied  and 
applied  on  the  same  lines  as  its  sister  cults,  the  lips  of 
humanity  affirm;  that  medicine  is  a  mystery,  and  its 
practice  largely  a  game  of  chance,  the  attitude  of  hu- 
manity at  large  attests. 

The  most  widely  consulted  books  on  popular  medicine 
bear  witness  to  this  truth.  An  abstract  principle  to  im- 
part a  philosophic  tone;  a  list  of  the  7iames  of  diseases — 
"  the  counters  of  wise  men,  but  the  money  of  fools,"  ac- 
cording to  Hobbes — treated  as  representing  each  a  fixed 
quantity,  to  give  an  appearance  of  precision;  a  formidable 
array  of  such  animal,  vegetable,  and  mineral  compounds 
as  can  most  surely  set  up  some  disturbance  in  the  bodily 
economy,  to  checkmate  with  their  movements  what  have 
been  assumed  to  be  the  invariable  and  deleterious  symp- 
toms of  unvarying,  and  essentially  noxious,  diseases;  and 
w^e  have  a  picture  of  the  "  Complete  Pocket  Physician  " 
according  to  the  popular  idea. 

It  is  the  play  of  "  Hamlet "  without  the  Prince  of  Den- 
mark; the  science  and  art  of  medicine  without  man. 


IV  PREFACE. 

I  have  written  this  book  in  order  to  rectify  the  omis- 
sion; in  order  to  introduce  man  to  the  reader  of  popular 
medicine.  I  have  ventured  even  to  confer  on  him  the 
leading  role,  have  made  him  tell  the  story  of  his  birth  and 
growth,  and  explain  the  functions  of,  and  the  source  of 
power  in,  that  wonderful  piece  of  mechanism,  his  body; 
to  prove  that  he  is  not,  as  is  calumniouslj'  asserted  of  him, 
the  sport  of  malignant  spirits  in  the  guise  of  diseases;  but 
the  well-cared-for  child  of  old  Dame  Nature,  who  leads  him 
by  what  are  called  functional  disorders,  as  tenderly  and  di- 
rectly as  is  possible,  back  to  the  j^aths  of  health  when  he  has 
strayed  therefrom;  and  purifies,  by  organic  disease,  his  race 
of  those  least  worthy  of  it  or  least  fitted  to  enjoy  it. 

In  the  close  study  of  man  and  of  his  relations  with 
Nature,  and  in  a  correct  interpretation  of  the  phenomena 
(the  symptoms)  attendant  on  his  disorders,  does,  in  my 
humble  opinion,  the  Science  of  Medicine  consist.  Treat- 
ment is,  then,  not  a  combat — of  which  the  battlefield  is 
the  patient's  body  —  between  a  treacherous  and  potent 
enemy,  disease,  and  a  physician  armed  with  chemical  thun- 
derbolts, but  a  partnership  between  Nature  and  her  disciple 
working  harmoniously  together  for  the  sufferei-'s  good. 

*'  Not  as  adventitious  therefore,"  says  the  greatest  of 
our  modern  philosophers,  "  will  the  wise  man  regard  the 
faith  that  is  in  him.  The  highest  truth  he  sees  he  will 
fearlessly  utter;  knowing  that,  let  what  may  come  of  it, 
he  is  thus  playing  his  right  part  in  the  world — knowing 
that  if  he  can  effect  the  change  he  aims  at — well:  if  not 
— well  also;  but  not  so  well." 

16  Orchard  Street,  Portman  Square,  W. 


CONTENTS. 


Preface pp.  iii-iv 

JV.  B. — Matty  diseases,  having  more  causations  than  one,  will  necessarily 
receive  notice  in  different  chapters  and  under  different  headings. 
The  index  will,  in  such  cases,  be  found  to  group  together  the  scat- 
tered references. 

PART  1. 

THE  SCIENCE    OF  MEDICINE. 
Introduction p.  1 

CHAPTER   I. 

THE    PRINCIPLES    OF   LIFE. 

Human  life  begins  in  a  germ-cell,  which  is  an  intricate  compound  of  six 
elements  ;  in  its  intricacy  is  to  be  found  the  source  of  its  only  energy, 
which,  though  small,  is,  in  conjunction  (under  certain  conditions)  with 
that  derived  from  soluble  albuminous  food,  sufficient  to  account  for 
the  phenomena  of  life  and  growth.  The  colloid  form  of  the  germ- 
cell  and  its  descendants  renders  them  specially  susceptible  to  the  in- 
fluence of  matter  and  energy  in  their  environment.  The  environment, 
plus  inherited  peculiarities  of  structure  in  the  germ-cell,  determine 
the  form,  and  thus  the  nature  and  character,  of  man.  The  motor 
power  in  man,  as  in  the  steam-engine,  is  derived  from  the  combustion 
of  fuel.  In  completely  formed  man  we  have  but  one  real  system,  the 
food-system,  specialized  departments  in  which  are  devoted  to  the 
guidance,  the  locomotion,  and  the  reproduction  of  the  body,  pp.  5-17 

CHAPTER   ir. 

THE   PRINCIPLES   OF  HEALTH. 

Health,  a  state  of  unstable  equilibrium  between  the  body  of  man  and  his 
environment,  in  some  striking  points  comparable   to  the  rhythmic 


VI  CONTENTS. 

movement  of  clockwork.  Since  all  men  diffei"  in  structure  no  one 
set  stiindard  of  environment  can  exist  for  all.  As  there  is  no  essen- 
tially perfect  environment,  so  can  there  exist  no  essentially  evil  one. 
Within  certain  limits,  and  provided  the  change  be  gradually  effected, 
the  human  body  can  adapt  itself  to  new  "aggregates  of  force."  Ex- 
amples of  this.     Conclusion, pp.  19-o3. 

CHAPTER   in. 

THE    PRINCIPLES    OF   ILL-HEALTH. 

Ill-health  consists  in  a  disturbance  of  the  equilibrium  of  health.  The  dis- 
turbing force  m:iy  be  slight  and  the  process  of  re-equilibration  {i.  e., 
fanctional  disorder),  in. consequence,  short  and  restorative  of  the  old 
state  of  balance;  or  more  powerful,  and  partially  destructive  of  the 
body  [i.  e  ,  organic  disease),  with  one  of  the  following  results:  either 
the  re-establishment  of  an  imperfect  equilibrium  {chronic  ill-heallh), 
in  which  the  rhythm  of  health  is,  more  or  less,  wanting,  and  which 
must,  except  under  special  conditions  of  environment,  end  in  premature 
death  ;  or  the  more  or  less  sudden,  complete,  and  permanent  over- 
throw of  all  equilibrium  {death).  The  symptoms  of  disease  are  al- 
ways beneficent,  are  the  visible  effects  of  the  excess  (the  disturbing) 
force  expending  itself  on  the  body  in  the  direction  of  the  least  resist- 
ance. Drugs  )nay  deflect  the  direction  tiiken  by  this  force,  or  n)ay 
cause  the  part  attacked  to  liberate  more  of  its  vital  force,  both  d()ul)t- 
ful  benefits  ;  they  are  impotent  to  check,  to  counterbalance,  the  real 
evil,  the  disturbing  force.  Examples  of  different  varieties  of  ill- 
health,      35-50 

CHAPTER    IV. 

TIIK    PRINCIPLES    OF    SCIE.NTIFIC    MEDICINE. 

Treatment  hy  Ordinary  Measures:. 

Resume  of  position.  The  ordinary  measures  of  treatment:  food,  dim  ;i  to, 
and  habit.  I.  Foods.  Rules  to  guide  us  in  their  administration. 
These  rules  as  modified  by  discnse.  Food  accessories  and  artificial 
digestive  agents.  II.  Climate.  The  purity,  temperature,  and  humid- 
ity of  the  air  and  the  effects  of  these  on  health.  III.  Habits  and 
modes  of  life.     Fallacies  of  hygienists.     General  rules,   .    pp.  51-86 

CHAPTER  V. 

THE    PRIXCH'LES   OK   SCIENTIFIC   MEDJCi.VE — {continued). 

Treatrnait  hy  Extraordinary  Measures. 

Extraordinary  measures  are  called  for  in  treatment,  because  extraordinary 
combinations   of  forces   are  relied  on   in   health   by  civilized   man. 


CONTENTS.  VU 

Medicines  may  act  in  any  one  of  the  following  ways  : — (a)  as  foods ; 
(6)  as  elements  of  disturbance,  of  which  nature  are  stimulants,  tonics, 
and  alteratives  ;  (c)  as  meclianical  scavengers  ;  or  {d)  as  antidotes.  An 
instance  of  the  treatment  in  a  case  of  gout.  The  fallacies  of  the  or- 
thodox drug  system  :  (a)  its  assumption  of  the  possibility  of  local  dis- 
ease; (b)  its  pretence  to  possess  drugs  that  act  only  locally;  (c)  its 
wrong  inductions ;  (d)  its  misinterpretation  of  the  phenomena  of  dis- 
ease, and  consequent  misapplication  of  remedies.  The  only  ration- 
al lines  of  treatment.  Physico-mental  agents.  Structure  of  the  ner- 
vous system  and  method  in  which  it,  and,  through  it,  the  whole  body, 
is  affected  by  these  agents, pp.  8'/'-122 


FAKT  II. 
THE  ART    OF  HEALING. 

Introduction pp.  125,  126 

No.  1.— (j:!)e  -foob  Stjstem. 

CHAPTER    YI. 

SOURCES   AND    DESTINY    OF   HUMAN   FOODS. 

1.  The  foods  of  man,  their  origin,  their  digestion,  and  their  uses.  2.  The 
Processes  of  Digestion.     3.  The  Organs  of  the  Food  System, 

pp.  127-138 

CHAPTER   YIT. 

DISEASES    DUE    TO    THE   DEFICIENCY   OF   FOOD. 

In  the  Food  System. — Loss  of  weight ;  loss  of  energy  ;  dyspepsia  (atonic 
form) ;  pallor  and  breathlessness ;  consumption  ;  general  breakdown 
of  organs, pp.  139-146 

In  the  Xertous  System. — Irritability;  hysteria;  hypochondriasis  ;  severe, 
prolonged  mental  depression  ;  insanity  (especially  at  puberty), 

pp.  146,  147 

T'reatment  of  all  Grades  nf  Deficiency. — 1.  Supply  digestible,  nourishing, 
simple  food  in  proportion  to  sufferer's  needs  and  powers,  exercising, 
at  first,  in  advanced  cases,  the  greatest  caution.  2.  Supply  oxygen, 
by  means  of  fresh  air,  to  consume  such  food,  and  to  thus  render  it 
available  for  the  bodily  requirements.  3.  Supply  exercise  sufficient 
to  the  removal  of  all  food-waste  from  the  muscles.  .  4.  See  that  cloth- 
ing, occupation,  and  habits  of  life,  be  suited  to  the  bodily  needs, 

pp.  147-152 


Vm  CONTENTS. 


CHAPTER   VIII. 

DISEASKS    DUE    TO    EXCESS    OF   FOOD. 


In  the  Food  System. — Acute  dyspepsia  :  Xausea,  acidity,  flatulence,  di- 
arrlioea,  colic,  etc.  Cltron'v-  dyspepsia  :  Acidity,  flattilenee,  constipa- 
tion, etc.  Corpulence.  Gout :  Acute  gout,  gouty  dyspepsia,  gouty 
skin  disease,  gouty  kidney  disease,  gouty  heart  disease,  gouty  lung 
disease,  etc.  Rheumatism  :  Rheumatic  fever,  heart  disease,  pleurisy. 
Biliousness  :  Jaundice,  dyspepsia.  Glucosuria.  Gall  stone.  Arterial 
decay.     BrighCs  disease^ pp.  153-214 

In  the  Xervous  System — Headache,  irritability  and  excitability,  recuirent 
attacks  of  depression  of  spirits,  some  forms  of  epilepsy,  pp.  153-214 

'i'REATMENT. — Acute  Dyspepsia  (Acute  Gastric  Catarrh). — Discontinue  near- 
ly all  feeding  for  a  day  or  two,  then  gradually  and  cautiously  return 
to  a  normal  dietary.  Let  the  patient  rest.  Empty  the  stomach  and 
bowels  by  a  purgative;  then  soothe  them  by  poulticing  and  by  ad- 
ministering, if  necessary,  bismuth,     pp.  159-161 

Chronic  Dyspepsia. — Cut  the  food  down  in  amount  and  quality  so  as  to 
suit  the  bodily  needs.  Avoid,  as  a  rule,  all  alcoholic  stimulant.  En- 
join exercise  in  the  open  air.  Remove  all  conditions  unfavorable  to 
the  general  health  of  the  body.  Give  no  drugs,  or  only  an  occasional 
purge, ' pp.  161,  162 

Gout. — Order  the  minimum  of  necessary  food,  but  allow  an  abundance  of 
water.  Exercise  fieely.  Frequent  hot  bathing.  Warm  clothing. 
Avoidance  of  worry  and  all  depressing  agents.  Bowels  to  be  kept 
regular.  Dry  climate.  Acute  gout  to  be  treated  by  rest,  application 
of  warmth  to  inflamed  parts,  very  restricted  dietary',  and  smart  pur- 
gation,     pp.  166-169 

Biliousness. — Simplify  the  dietary,  enjoin  abundant  exercise,  and  keep 
the  bowels  regular, pp.  1*71-177 

Rlienmatum  (Chronic). — A  minimum  of  necessary  food.  Abundant  (not 
excessive)  exercise.  Warm  clothing.  A  dry  climate.  Frequent 
bathing,  followed  by  prolonged  friction  of  muscles.  Acute  rheuma- 
tism, treated  like  the  fevers,     pp.  183-191 

Glucosuria  (Functional  Dlabete.'*). — Lessen  amount  of  starchy  and  sacchar- 
ine articles  of  food.     Exercise.     Improve  general  health,  pp.  198-200 

Gallstone. — Simple  diet.     Rest.     Surgical  measures,     .     .      pp.  201,202 

Corpulence. — Exercise.  Take  little  fluid  with  food.  Avoid  fattening 
articles.     Reduce  diet  scale  to  minimum  necessary,     .      pp.  206-210 


CONTENTS.  IX 


CHAPTER   IX. 

DISEASES   DUE  TO    UNSUITABLE    FOOD. 

I.  Foods  absolutely  Unfit  for  All  Men. — The  flesli  of  animals  that  have 

given  lodgment  to  such  parasites  as  tape-worm  and  trichina,  or  that 
have  died  of  certain  febrile  diseases,  or  that  have  been  dosed  with 
such  drugs  as  arsenic  and  antimony.  Decomposing  meat.  Meal 
made  from  blighted  wheat,  barley,  or  rye,  or  that  in  the  process  of 
grinding  has  become  contaminated  by  lead,  etc.  Water  containing 
certain  soluble  salts,  especially  oxide  of  lead,  or  that  contaminated  by 
decomposing  animal  products, ,     .     pp.  215-237 

II.  Foods  Unfit  for  Some  Men. —  Unfit  for  all  ivhose  dir/enlive  poivers,  hy 

reason  of  latent  gout,  chronic  biliousness,  general  debility,  or  other 
cause,  are  defective. — Fat  when  hot,  or  when  mixed  with  condiments, 
•etc.,  as  in  ragouts.  P'at  {e.  g.,  butter  or  lard)  intimately  compounded 
with  flour  and  sugar,  as  in  pastry,  sweet  cakes,  etc.  Fat  becoming 
at  all  rancid.  Imperfectly  cooked  starch,  as  in  boiled  potatoes,  in 
some  pastry,  etc.  Uncooked  vegetables,  as  a  rule.  Sugar  in  laro-e 
quantities.     Sweet  wines.     Tea,  under  some  conditions,  pp.  237-251 

Iir.  The  questions  of  alcohol,  vegetarianism,  low  diet,  milk  diet,  and 
grape  diet  discussed, pp.  251-272 

CHAPTER   X. 

diseases  due  to  imperfect  digestion. 

Effects  of  Failure  of  Digestion. 

Regions  where  Digestion  Takes  Place. — (a)  Mouth. — In  the  mouth 
there  arc,  practically,  no  signs  of  primary  failure.  It  reflects,  how- 
ever, owing  to  its  intimate  nerve  connections,  the  derangements  of 
the  stomach.  Thus,  in  atony  of  the  stomach,  the  mouth  is  clean  but 
pale,  and  the  tongue  usually  clear,  but  in  inflammatory  derangements 
of  the  organ  the  mouth  is  foul  and  congested,  the  tongue  thickly 
furred,  and  the  taste  greatly  vitiated,     .     .     .     ,     .     .pp.  275-278 

(6)  Stomach. —  (1)  Weakness  of  Stomach=atonic  dyspepsia,  a  portion  of 
general  muscular  or  nervous  debility.  (2)  Inflammatory  disorder  of 
stomach  =  acute  or  chronic  gastric  catarrh,  the  result  of  over-stim- 
ulation of  the  organ,  but  sometimes  due  to  acute  gout.  (3)  Degen- 
erative disease  of  stomach — e.  g.,  cancer  or  ulcer.     Very  rare, 

pp.  279-289 

(c)  Intestines. — (1 )  Weakness  of  intestine,  a  portion  of  general  want  of  tone 

A* 


X  CONTENTS. 

in  tlie  body,     (2)  Inflammatory  disorders  due  to  irritation.     (3)  De- 
generative disease — c.^.,  cancer,  ulceration,  etc.,      .     .      pp.  2S9-297 

((/)  Liver  (secondary  digestion). — Functional. — Gout.  Biliousness.  Gall 
stone.  Giucosuria  (of  one  kind).  Albuminuria  (of  one  form).  De- 
generative.— Cirrhosis  of  the  liver.  Waxy  degeneration  of  the  liver. 
Fatty  degeneration  of  the  liver.  Cancerous  degeneration  of  the  liver. 
Acute  yellow  atrophy  of  the  liver,  etc., pp.  297-301 

(j)  Tissues  (terfiari/  digestioii). — Obesity.  Rheumatism.  Probal)ly  many 
other  aihncnts  but  little  traced  out  as  yet,      ....      pp.  301-305 

Treatmknt. — Of  atony  of  stomach  and  intestines.  Improve  general  health. 
Of  inflammatory  derangements  of  stomach  and  intestines.  Remove  all 
sources  of  irritation,  soothe  the  organs,  giving  the  simplest  and  light- 
est foods.  Improve  general  health.  Of  degenerative  diseases  of 
stomach  and  intestines.  Soothe,  and  seek,  with  extreme  caution,  to 
nourish.  Of  the  five  functional  disorders  of  the  liver.  Improve  gen- 
eral health.  Simplify  to  the  uttermost  the  dietary.  Plenty  of  exer- 
cise and  of  fresh  air.  Of  obesity  and  of  rheumatism  the  treatment 
must  be  very  specially  adapted  to  each  case,  but  exercise,  simple  diet- 
ary, a  dry  climate,  and  suitable  clothing  Avill,  in  all  ca.=es,  effect  much 
good, pp.  275-306 

CHAPTER  XI. 

DISEASKS    DUE    TO    DEFECTS    IN    THE    ORGANS    OF   THE    FOOD    SYSTEM. 

Disorders  of  the  Heart  and  Blood-vessels. 

Sketch  of  Normal  Heart  Functions. — The  return-blood  from  the  body 
(the  venous  blood)  is  poured  into  the  right  side  of  the  heart,  whence 
it  is  pumped  through  the  lungs  (where  it  is  charged  with  oxygen)  to 
the  left  side  of  the  heart.  It  enters  the  ventricle  (the  main  cavity) 
of  the  left  side,  by  the  mitral  orifice.  This  oiifice  is  provided  with 
valves,  the  mitral  valves,  which  close  when  the  ventricle  contracts  to 
force  the  blood-current  onward  to  the  tissues.  The  opening  by  which 
blood  passes  on  to  the  tissues  is  called  the  aortic  orifice,  and  it  is  also 
provided  with  valves,  the  aortic  valves,  which  prevent  the  regurgita- 
tion of  the  blood  into  the  ventricle  wiien  this  structure  dilates  to  take 
in  a  fresh  supply  of  blood.  The  structure  of  the  right  side  of  the 
heart  is  closely  similar  to  that  of  the  left,  but  it  is  but  very  rarely 
the  seat  of  disease, pp.  309-318 

Sketch  of  the  Valvular  Diseases  of  the  Heart. — (a)  When  the  mitral 
orifice  is  contracted,  tiiere  must  therefore  ensue  :  first,  a  slow  engorge- 
ment (congestion)  of  the  lungs,  then  an  engorgement  of  the  right 
side  of  the  heart,  then  a  similar  state  in  the  veins  all  over  the 
body  (inducing  passive  congestion  of  all  organs),  and  finally  dropsy. 


CONTENTS.  XI 

{fi)  Wlien  the  mitral  valves  have  been  re7idered  incampetent  by  disease, 
the  same  backward  engorgement  will  take  place,  but  the  process  will 
l;e  a  slower  one.  There  will  also  be  some  increase  in  size  of  the  left 
ventricle,  (c)  Wlieu  the  aortic  orifice  is  contracted,  there  will  be  great 
enlargement  of  the  left  ventricle,  which  for  a  time  will  compensate 
for  the  obstruction.  To  this  will  succeed  a  bagging-out  and  fail- 
ure to  contract  of  the  ventricle,  and  then  gradually  all  the  secondary 
consequences  of  mitral  disease.  There  will  be,  however,  in  advanced 
stages,  some  risk  of  sudden  death  on  great  exertion,  (d)  When  the 
aortic  valves  are  incompetent,  there  will  be  a  constant  reflux  of  blood 
from  the  aorta  and  embarrassment  of  the  left  ventricle,  telling  back 
gradually  on  the  right  side  of  the  heart  and  on  the  whole  body.  In 
advanced  stages  sudden  effort  may  prove  fatal.  The  diseases  of  the 
orifices  or  valves  of  the  heart  are  due  to  a  puckering  of  their  inner 
linings,  the  result  of  inflammation  of  these  linings  such  as  is  of  com- 
mon occurrence  in  rheumatic  fever.  Treatment. — Caution  as  to  great 
exertion  and  maintenance  of  the  general  health  often  prevent  the  oc- 
currence of  any  distressing  symptoms  in  heart  disease,  and  suffice  to 
prolong  life  to  the  natural  term.  Other  less  common  forms  of  heart 
disease  considered.    Arterial  and  venous  diseases,   .     .     pp.  314-335 

CHAPTER   XII. 

DISEASES   DUE   TO   DEFECTS    IN   THE    ORGANS    OF   THE    FOOD    SYSTEM. 

Disorders  of  the  Blood  and  JBlood-mahing  Glands. 

The  Disorders  of  the  Blood. — ^I.  Due  to  non-livinc^ poisons  in  the  Blood — 
e.  ^.,  lead,  arsenic,  mercury,  etc., pp.  340-344 

II.  Due  to  living  poisons  {Bacteria)  in  the  Blood,  producing  the  Fevers. — 

(a)  Bacteria  that  enter  by  the  stomach  or  lungs  cause  the  following 
diseases:  Simple  Continued  Fever,  Mumps,  Influenza,  Measles,  Epi- 
demic Roseola,  Scarlet  Fever,  Typhoid  Fever,  Typhus  Fever,  Famine 
Fever,  Yellow  Fever,  Dengue,  Small-pox,  Chicken-pox,  Remittent  Fe- 
ver, Intermittent  Fever  (Ague),  Epidemic  Cerebro-spinal  Meningitis, 
Cholera,  Diphtheria  and  Diphtheritic  Croup,  Whooping-cough,  {h) 
Bacteria  that  enter  only  by  a  wound  cause  the  following:  Syphilis, 
Tuberculosis,  Erysipelas,  Pyasmia,  Tetanus,  Hydrophobia,  pp.  344-389 

III.  Due  to  unhiown  changes  in  the  Blood. — Purpura  ;  Scurvy,  pp.  389,  390 

The  Diseases  of  the  Blood-forming  Glands. — Leucocythasmia;  Adenia; 
Addison's  Disease ;  Progressive  Pernicious  Anaemia  ;  Simple  Anaemia  ; 
Chlorosis  ;  Exophthalmic  Goitre pp.  391-397 


Xll  CONTENTS. 


CHAPTER  XIII. 

DISEASES    DUE    TO    DEFECTS    IN    THE    ORGANS    OF    THE    FOOD    SYSTEM. 

Disorders  of  the  Lyrophalics. 

Arrangement  and  Fl'NCtions  of  the  Lymphatic  Organs. — Functional 
Disorders  of  the  Lymphatics.  —  Acute  and  Chronic  Rheumatism; 
Syphilis  ;  and,  to  some  extent,  Gout, pp.  401-408 

Degenerations  of  the  Lymphatics. — Scrofula;  Inherited  Syphilis;  the 
Sequelfc  of  Syphilis;  Leucocythaemia ;  Adenia;  Addison's  Disease, 
etc., pp.  408-419 

CHAPTER    XIV. 

diseases  due  to  defects  in  the  organs  of  the  food  system. 

Disorders  of  the  Skin  and  Kidneys. 

Functions  of  the  Skin. — No.  1.  Skin  Diseases  due  to  Blood  Poisons. — 
(a)  To  Micro-organisms. — The  fever  eruptions, p.  423 

(b)  To  Gout. — Eczema,  Acne  (red  and  simple  varieties),  etc.,  pp.  425-428 

{<■)  To  Syphilis. — Roseolous  Eruptions ;  some  varieties  of  Eczema,  of 
Ecthyma,  of  Lichen,  of  Pityriasis,  and  of  Psoriasis  ;  Rupia,  etc., 

pp.  428,  429 

(«^/)  To  other.,  various.,  impurities  :  Affecting  the  Sweat-glands. — Hyperi- 
drosis  ;  Dysidrosis  ;  Sudamina.  Affecting  the  Sebaceous  Glands  of 
the  Skin. — Seborrlioea  ;  Comedones ;  Acne  (of  some  forms) ;  Mol- 
luscum  ;  Boils  ;  Xanthelasma.  Affecting  the  Hair  and  Nails. — 
Various  small  derangements.  Affecting  the  Nerves  of  the  Skin. 
— Nettle-rash  ;  Prurigo  ;  Shingles.  Affecting  the  Skin  Proper. — 
Lichen  ;  Erythema  nodosum  ;  Carbuncle,     .     .     .     pp.  429-436 

Xo.  2.  Skin  Diseases  due  to  Failure  of  other  Eliminating  Organs. — 
(a)   To  Kidney  Failure. — Carbuncles,  Boils,  Prurigo,  Lichen,  etc., 

p.  436 

(6)  To  Lung  Failure. — Various  small  derangements,     ....  p.  436 

(r)   To  Liver  Failure. — Xanthelasma,  Pruiigo,  etc., p.  436 

(d)  To  Failure  in  the  I^ymphatics. — Lupus ;  Pemphigus ;  Lichen  Scro- 
phulosorum  ;  Psoriasis  ;  Impetigo  ;  Pityriasis ;  Ichthyosis, 

pp.  436^40 

Undassifiahle  Skin  Affections. — Scleroderma;  Elephantiasis  (Leprosy), 

pp.  440,  441 

No.  3.    Skin  Diseases  due  to  Parasites. — («7)   To  Vegetable  Parasites. — 

The  Ringworms, pp.  441-443 

(6)  To  Animal  Parasites. — Phthiriasis  (due  to  lice);  Itch,  pp.  444-446 


CONTENTS.  XIU 

Disorders  of  the  Kidneys. — Fiindional  Disorders. — Albuminuria  ;  Chy- 
luria  ;  Hsematinuina  ;  Phospliaturia ;  Inflammation  of  the  Kidneys  ; 
Polyuria, pp.  446-451 

Degenerations  of  the  Kidneys. — Chronic  inflammatory  Blight's  Disease ; 
Waxy  Bright's  Disease ;  Fatty  Bright's  Disease ;  Cancer  of  the  Kid- 
neys ;  Scrofulous  Disease  of  the  Kidneys ;  Cystic  Degeneration  of  the 
Kidneys, pp.  452-455 

CHAPTER  XV. 

DISEASES    DUE    TO   DEFECTS    IN    THE    ORGANS    OF    THE    FOOD    SYSTEM. 

Disorders  of  the  Lungs,  Throat,  and  Windpipe. 

Fx'NCTiONS  AND  STRUCTURE  OF  THE  LuxGS. — Fnnctio7icd  Disorders  of  the 
Lungs. — (a)  Bronchitis  (coarse  variety) ;  (6)  Bronchitis  (fine,  capillary 
form);  (c)  Pneumonia  ;   (o?) Pleurisy, pp.  45 9-4 Y4 

Degenerations  of  the  Lungs. — Consumption  (tubercular  form,  inflam- 
matory form,  and  fibroid  form)  ;  Cancer ;  Mortification  ;  Abscess, 

pp.  474-476 

Other  Conditions  of  the  Lungs. — Asthma  (a  nerve  derangement);  Bron- 
chiectasis (a  dilatation  of  the  bronchial  tubes) ;  Emphysema  (a  dila- 
tation of  the  air-cells  ;  Collapse  (a  mechanical  arrest  of  function) ; 
Congestion  (a  transient  or  permanent  condition  of  the  circulation) ; 
Hagmoptysis  (a  symptom), pp.  476-484 

Disorders  of  the  Tliroat. — ^Derangement  of  the  tonsils  ;  the  inflamed,  re- 
laxed, or  congested  throat, pp.  484-486 

Disorders  of  the  Larynx. — Inflammation  of  the  larynx  (in  children  pro- 
ductive of  real  croup) ;  Congestion  of  the  larynx ;  Spasm  of  the 
larynx  (false  croup), pp.  486-490 

No.  2.— ^i)e  K'^rtJcus  Ssst^m. 

CHAPTER   XVI. 

FUNCTIONAL   NERTE   DISORDERS, 

The  Nertous  System. — Lis  Functions. — Its  Functional  Derangements. — (a) 
Due  to  Kervo^is  Strain  at  certain  times  of  life. — Hypochondiiasis  ; 
Hysteria ;  Mental  Depression  ;  Temporary  Insanity,  etc.,  pp.  495-502 
(6)  Due  to  Impurities  in  the  Blood. — Depression  of  Spirits ;  Irritabili- 
ty;  Sleeplessness;  Neuralgia;   Hallucinations,  etc.,  pp.  502-505 
(f)  Due   to  Misuse  [OverioorJc,  etc.)  of  the  Kei'vous  System. — Writer's 
Cramp  ;   Delirium   Tremens  ;  Chorea  (?)  ;  Xeuralgia ;  Migraine ; 
Spinal  Irritation  ;  Local  Palsies, pp.  505-508 


XIV  CONTENTS. 

(J)  Due  to  Reflex  Causes. — Infantile  Convulsions ;  Hysteric  and  Hystero- 
epileptie  Fits  ;  Epilepsy  (functional  variety) ;  Catalepsy ;  Tetany  ; 
Functional  Paralysis, pp.  508-518 

CHAPTER   XVII. 

ORGANIC    NERVE    DISOHDERS. 

The  Nervous  System. — Its  Organic  (^Degenerative)  Diseases. — 1.  Of  certain 
Cranial  Nerves  and  of  their  Roots. — Bell's  Palsy  ;  Bulbar  Palsy, 

pp.  521-525 

2.  Of  the  Spinal  Cord. — Infantile  Palsy ;    Creeping  Palsy  ;    Sub-acute 

Inflammation  of  Anterior,  Gray  Horn  in  the  Spinal  Cord  ;  Pseudo- 
hypertrophic Palsy ;  Spastic  Spinal  Palsy ;  Locomotor  Ataxia  ; 
Acute  Ascending  Palsy, pp.  625-530 

3.  (a)  Of  the  Lower  Brain-centres. — Cerebro-spinal  Sclerosis  ;    Shaking 

Palsy ;  Athetosis, pp.  530-532 

(6)  Of  Various  Portions  of  the  tvJioIe  Brain. — Apoplexy;  Cerebral 
Thrombosis  ;  Cerebral  Congestion  ;  Cerebral  Anaemia  ;  Cerebral 
Inflammation  ;  Cerebral  Softening, pp.  532-535 

(f)  Of  Membranes  of  the  Brain. — Simple  Meningitis ;  Tubercular  Men- 
ingitis ;  Pachymeningitis ;  Hydrocephalus  (water  on  the  brain), 

pp.  535-537 

4.  Of  the  Higher  Brain-centres. — Insanity ;  Dementia ;  Organic  Epilepsy ; 

Sunstroke,  etc., pp.  53*7-549 

No,  3.— (jl)e  iHotor  Sjjstem. 

CHAPTER  XVIII. 

disorders  of  the  motor  system. 

The  Motor  System. —  The  Muscles. — Their  Functional  and  Organic  Dis- 
orders,       pp.  553-555 

The  Ligaments, p.  555 

The  Bones. — («)  TJicir  Functional  Disorders,  ....  pp.  555,  55G 
[li)  TJieir  Organic  Disorders. — Caries ;  Necrosis ;  Periostitis,  pp.  556-558 
(c)   Their  Degenerations. — Rickets ;  Osteomalacia ;  Osteitis  deformans, 

pp.  558-560 

No.  4.— ®I)c  Ucprobnctinc  Sjjstem. 

CHAPTER  XIX. 

disorders  of  the  reproductive  system. 

The  Reproductive  System. — Brief  General  Remarks  on  the  Functional 
and  Organic  Disorders  of  this  System, pp.  563-567 


CONTENTS.  XV 


APPENDICES. 

I.  Formula, pp.  571-574 

II.  Hints  on  Diet, pp.  575-581 

(a)  Diet  in  Health. 
(fj)  Diet  in  Sickness. 

Diet  in  Fever. 

Diet  in  Chronic  Gout,  Dyspepsia,  and  Biliousness. 

Diet  in  Scrofula  and  in  the  Early  Stages  of  Consumption. 

Diet  in  Diabetes. 

Diet  in  Constipation. 

III.  Arrangement  of  the  Sick-room, p.  582 


Index, pp.  583-593 


PART    I. 

TRE  SCIENCE  OF  MEDICINE, 


INTRODUCTION. 

The  art  of  healing  is  built  on  the  science  of  medicine, 
as  that  of  calculation  rests  on  the  science  of  mathematics. 

The  science  of  medicine  deals  with  the  relationship  of 
physical  law  to  the  life  and  health  of  man. 
1 


CHAPTER  I. 

THE  PRINCIPLES  OF  LIFE. 

Human  life  begins  in  a  germ-cell,  which  is  an  intricate  compound 
of  six  elements;  in  its  intricacy  is  to  be  found  the  source  of 
its  only  energy,  which,  though  small,  is,  in  coojunction  (under 
certain  conditions)  with  that  derived  from  soluble  albuminous 
food,  sufficient  to  account  for  the  phenomena  of  life  and 
growth.  The  colloid  form  of  the  germ-cell  and  its  descendants 
renders  them  specially  susceptible  to  the  influence  of  matter 
and  energy  in  their  environment.  The  environment,  plus  in- 
herited peculiarities  of  structure  in  the  germ-cell,  determine  the 
form,  and  thus  the  nature  and  character,  of  man.  The  motor 
power  in  man,  as  in  the  steam-engine,  is  derived  from  the 
combustion  of  fuel.  In  completely  formed  man  we  have  but 
one  real  system,  the  food-system,  specialized  departments  in 
which  are  devoted  to  the  guidance,  the  locomotion,  and  the  re- 
production of  the  body. 


CHAPTER  I. 
THE  PRINCIPLES  OF  LIFE. 

"  For  dust  thou  art,  and  unto  dust  sbalt  thou  return."— Genesis. 

In  kind  organic  or  inorganic,  man,  as  long  as  he  is  called 
man — from  conception  to  disintegration — is  but  that  which 
the  Divine  voice  first  described  him — dust. 

"  You  are  dust,"  says  modern  science,  "  growing,  mov- 
ing, thinking,  propagating  dust,  and  your  death  is  but  the 
consequence  of  what  you  call  life." 

Let  us,  in  this,  chapter,  briefly  study  the  facts  on  which 
these  dicta  of  God  and  of  science  rest, 

Man  enters  on  life  a  germ-cell,  microscopical  in  size, 
spheroid  in  shape,  colloid  in  character;  a  chemical  com- 
pound of  six  simple  elements. 

First  we  will  discuss  the  six  elements,  and  show^  that 
these,  though  of  ordinary  kind,  are  each  possessed  of  some 
striking  character,  calculated  d  priori  to  make  their  union 
what  it  is,  an  eventful  one,  fruitful  in  surprises.  The 
names  of  these  elements  are,  hydrogen,  oxygen^  nitrogen, 
carbon,  sulphur,  and  phosphorus. 

]^ow,  the  first  four  of  these  offer  at  once  a  striking  ex- 
ception to  the  general  rule,  that  all  matters  may  exist  as  a 
solid,  liquid,  or  gas,  for  oxygen,  hydrogen,  and  nitrogen 
are  known  to  us  but  in  the  gaseous  form,  while  carbon  is 
ever  a  solid.  Then,  five  of  our  elements  possess  a  protean 
character,  for  phosphorus  may  exist  either  as  a  yellow  and 


THE    PRINCIPLES    OF    LIFE. 


most  inflammable  solid,  or  as  a  red  and  singularly  incom- 
bustible one ;  carbon,  as  the  very  different  substances, 
plumbago,  charcoal,  or  the  diamond;  oxygen,  as  simple 
oxygen  or  as  ozone;  sulphur  is  known  in  three  distinct 
characters;  while  hydrogen  is,  with  some  reason,  suspect- 
ed of  being  the  parent  of  all  the  so-called  elements,  itself 
the  sole,  iinal,  real  element.  Then  hydrogen,  carbon, 
phosphorus,  and  sulphur  possess,  among  elements,  remark- 
ably weak  chemical  aftinities,  the  compounds  into  which 
they  enter  being  marked,  therefore,  by  instability ;  while 
nitrogen — as  we  know  from  our  familiar  explosives,  of 
which  it  constitutes  the  essential  ingredient,  the  fons  et 
origo  mali — is  so  fickle  in  its  chemical  unions  that  it  flies 
away,  a  solitary  gas,  on  the  smallest  provocation.  So  es- 
sential is  this  instability  of  nitrogen  to  life  that  the  phrase 
"  There  is  no  life  without  nitrogen  "  has  long  since  become 
a  recognized  axiom,  to  which  no  exception  is  known  to 
exist,  either  in  the  vegetable  or  the  animal  world. 

The  atoms  of  the  above  six  elements  combined  in  large 
molecules  of  exceedingly  complex  structure*  are  the  fac- 
tors of  the  germ-cell.  It  is  in  this  complexity  of  molecu- 
lar arrangement  that  is  to  be  found  the  key  to  the  phe- 
nomena of  life. 

But  in  what  way  ? 

It  is  an  elementary  fact  in  chemistry  that  the  more  com- 
plex the  molecule  of  a  compound,  the  more  prone  is  that 
compound  to  undergo  change  in  the  direction  of  simplifi- 
cation. In  other  words,  a  compound  possesses,  in  propor- 
tion to  its  complexity,  latent  energy  which  prompts  it  to 
move  in  the  direction  of  simplification. 

Now,  the  human  germ-cell  is  admitted  by  scientists  to 


*  These  molecules  consist  each  of  several  hundred  constituent 
atoms. 


THE    LATENT    ENERGY    OF    THE    GEEM-CELL.  7 

be  of  such  exceeding  molecular  complexity  as  to  defy  all 
attempts  at  giving  to  it  a  rational  chemical  foraiula.  It 
therefore,  pre-eminently  among  chemical  compounds,  pos- 
sesses the  energy  of  which  I  have  spoken. 

In  itself,  however,  there  is  nothing  extraordinary  either 
in  this  energy  or  in  its  amount,  for,  exposed,  alone,  to  the 
influence  of  the  atmosphere,  the  germ-cell  in  a  few  days  has 
spent  its  energy,  lived  its  life,  reached  its  goal,  passed 
from  complex  organic  to  simple  inorganic  dust,  without 
one  striking  phenomenon  to  indicate  the  passage,  while 
this  same  germ-cell,  if  shielded  from  the  air,  surrounded 
with  organic  matter  like  to  itself  in  stored  energy,  and 
supplied  with  the  necessary  conditions  (warmth,  moisture, 
etc.)  to  chemical  action,  could  have  grown  and  developed 
into  a  man. 

Does  the  reader  wonder  at  this  statement,  a  dozen  fa- 
miliar analogies  may  be  found. 

Let  him  take  a  key  and  wind  up  one  of  those  master- 
pieces of  horological  skill,  a  clock  that  indicates,  for  the 
space  of  a  ye^r,  the  seconds,  minutes,  hours,  days,  and 
months  on  its  dial  plates ;  in  other  words,  let  him  trans- 
fer from  the  muscles  of  his  arm,  though  unconscious  of 
the  loss  thereof,  to  the  steel  clock-spring  a  certain  amount 
of  energy,  su^eient,  pi'ovided  other  tnaterial  iiicnnely,  the 
clock  mechanism)  he  suitahly  adapted  thereto,  to  maintain, 
for  a  very  long  period  of  time,  all  the  complicated  clock 
movements  in  regular  order.  Let  him  also  expend  the 
same  amount  of  force  on  an  unattached  clock-spring,  and 
in  a  few  seconds,  and  with  but  trifling  movements,  the 
spring  lies  before  him  uncoiled  and  forceless,  though  pre- 
cisely the  same  energy  has  been  expended  in  both  instances 
and  on  precisely  the  same  material. 

Is  it  not  thus  with  the  germ-cell?  It  is  prepared  in  a 
human  body,  stored  with  but  such  a  fraction  of  the  total 


8  THE    PRINCIPLES    OF    LIFE. 

bodily  energy  that  the  loss  is  iinfelt  by  its  bestower,  and 
yet  is  it  sufficiently  endowed,  promded  the  material  neces- 
sary thereto  he  brought  m  contact  loith  it,  to  perform  all 
the  functions  that  appertain  to  life,  the  cell  having,  more- 
over, this  enormous  advantage  over  the  clock-spring,  that 
the  material  on  which  it  acts,  itself  brings  to  the  produc- 
tion of  the  phenomena  witnessed  vast  stores  of  energy  in 
the  organized  material  from  the  bodies  of  the  plants  and 
animals  used  as  food  ? 

Let  us  now  turn  to  the  character  of  the  germ-cell.  I 
have  called  it  a  colloid.     What  means  this  word  ? 

All  solid  matter  presents  itself  in  one  of  two  forms,  the 
crystalloid  and  the  colloid,  each  form  possessing  a  certain 
raison  d^etre  and  certain  characteristics,  of  which  we  will 
discuss  those  that  bear  upon  the  life  of  man. 

The  crystalloid  is  a  firm  solid.  Its  shape  may  vary  in- 
finitely. Its  growth  is  by  accretion — ^.  e.,  by  its  surfaces 
only,  for  these  alone  are  affected  by  its  surroundings — 
and  is  without  fixed  limit.  It  is  a  compound  of  compara- 
tively simple  molecules,  the  atoms  of  which,  have  for  each 
other  strong  afiinity.  It  is  more  or  less  soluble  in  wa- 
ter. The  crystalloid  is  the  form  of  nearly  all  inorganic 
matter. 

The  colloid  is  a  jelly.  When  not  subject  to  compres- 
sion, it  assumes  a  S2)herical  outline ;  it  is  permeable  by 
water  containing  dissolved  crystalloids  in  solution;  it  can 
grow,  therefore,  by  increase  in  size  of  its  constituent 
parts,  as  well  those  internal  as  those  external,  and  it  may 
therefore,  throughoid  its  whole  thickness,  be  influenced  by 
its  surroundings.  Its  limit  of  size  is,  in  the  more  complex 
colloids, ^^a;ec?,  increase  in  total  size  being  therefore  accom- 
panied by  the  appearance  of  fresh  spherical  colloids,  for  its 
constituent  parts,  always  many-atomed  molecules,  have  for 
one  another  but  feeble  chemical  attraction.     It  is  rarely 


THE  LATENT  ENERGY  OF  THE  GERM-CELL.        9 

soluble  in  water.  The  colloid  is  the  form  of  all  living 
organic  matter. 

In  the  colloid  character  of  a  germ-cell  we  have  an  ex- 
planation of  its  growth.  At  conception  it  is  encased  in 
crystalloid  food;*  give  it  but  moisture  to  dissolve  the 
crystalloids  and  carry  them  to  its  innermost  molecules; 
give  it  heat  favorable  to  all  chemical  change,  and  the  fact 
that  in  a  few  days  there  is  no  longer  one  single  germ-cell, 
but  a  number  of  closely  packed  similar  cells,  is  no  longer 
inexplicable;  continue  the  process  by  first  supplying  dis- 
solved crystalloids  from  the  maternal  blood,  and  later  on, 
during  extra-maternal  life,  from  the  once-living  parts  of 
plants  and  animals,  and  you  have  the  principle  and  the 
secret  of  growth. 

But  what,  the  reader  may  inquire,  about  the  phenomena 
of  life  ?  The  interaction  of  cell  and  cell-food  accounts  for 
the  building  of  the  perfect  mechanism,  the  combustion  of 
fuel,  as  we  shall  presently  see,  for  the  exhibition  of  all 
other  varieties  of  so-called  vital  force. 

Let  us  here  draw  attention  to  a  fact  already  mentioned 
— one  that  has  a  great  bearing  on  the  question  of  human 
life.  The  growth  of  the  cell-colloid  takes,  as  we  have 
seen,  of  necessity,  the  form  of  a  multiplication  of  cells. 
From  this,  at  first  sight,  we  might  be  led  to  think  that 
each  cell  was,  in  some  measure,  an  independent  being,  and 
not  really  an  integral  part  of  the  whole  ;  but  this  is  not 
so,  for  dissolved  crystalloids  pass  on  from  one  cell  to  an- 
other just  as  they  Avould  through  one  vast  single  cell,  each 
cell  having  only  an  outline,  its  several  parts  being  only 
held  together  by  attraction,  and  not,  as  was  formerly  suj)- 
posed,  by  an  encircling  wall  converting  each  into  a  sepa- 
rate being.      Man   is  not,  then,  what   at  first   sight  the 

*  Or  food  convertible  readily  by  heat  and  moisture  to  the  crys- 
talloid forni. 
1* 


10  THE    PEI^XIPLES    OF    LIFE. 

microscope  might  seem  to  prove,  a  species  of  colony,  but 
a  single  individual  composed  of  many  cells,  each  of  which 
is  an  integral  part  of  the  whole  being. 

To  sum  up:  A  germ-cell  grows  because  it  is  permeated 
by  dissolved  crystalloids,  with  which  its  molecules  can 
form  unions,  the  powers  of  movement,  thought,  etc.,  pos- 
sessed by  all  higher  animals  after  a  certain  stage  of  exist- 
ence is  reached,  being  distinct  processes  dependent  upon 
the  heat  energy  evolved  in  the  combustion  of  certain  ar- 
ticles called  fuel-foods. 

Having  now  discussed  the  manifold  properties  pos- 
sessed by  the  constituent  elements  of  a  germ-cell,  their 
elaborate  molecular  arrangement,  and  the  peculiar  facili- 
ties offered  by  the  colloid  form  to  the  action  of  crystal- 
loid material  in  solution,  we  may  devote  a  few  pages  to 
the  rationale  of  the  development,  life-history,  and  death 
of  the  human  body. 

The  JEnmronment  of  the  Germ-cell  and  of  its  Progeny. 

The  germ-cell,  indej)endently  of  its  environment,  is,  as 
w^e  have  seen,  of  the  most  trifling  importance ;  it  is  on 
the  adaptability  of  this  latter  to  the  stored  energies  in 
the  cells  that  growth,  life,  and  development  entirely 
depend. 

Growth,  we  now  know,  is  the  result  of  chemical  union 
between  the  molecules  of  the  germ-cell  (and  of  its  progeny) 
and  certain  dissolved  crystalloids  brought  to  them.  These 
crystalloids  must,  how^ever,  be  of  one  special  kind,  and  ap- 
proach, in  the  nature  and  variety  of  their  elements  and  in 
their  complexity  of  structure,  closely  to  the  cell  or  cells 
with  which  they  are  to  unite,  for,  were  they  of  simple  in- 
organic kind,  it  is  clear  that  the  passage  from  the  molec- 
ular complexity  of  a  living  cell  to  the  simplicity  of  inor- 
ganic molecular  arrangement  would  be  sudden  and  quick, 


THE    ENVIRONMENT    OF    THE    GERM-CELL.  11 

and  that,  in  consequence,  life,  instead  of  extending  over 
many  years  and  being  rich  in  phenomena,  would  come  to 
occupy  but  the  space  of  a  few  days,  hours,  minutes,  or  even 
seconds. 

Whence  are  such  necessary  crystalloids  to  come  ?  From 
the  living  bodies  of  animals  and  plants,  whose  colloid  cells, 
changed  by  a  process  called  digestion  to  crystalloids,  and 
dissolved  in  water,  are  carried  from  the  first  to  the  last 
moments  of  life  to  the  living  cells  of  man  to  act  as  his 
food.  Prior  to  birth,  these  necessary  substances  are  sup- 
plied already  digested  by  the  maternal  blood-stream  ;  after 
that  period  man  has  to  digest  them  for  himself,  his  blood, 
however,  always  keeping,  in  the  form  of  serum,  a  reserve 
stock  on  hand,  which  does  not  fail,  provided  only  water 
be  supplied,  for  many  days,  even  when  no  food  whatever 
is  consumed. 

Let  us  now  turn  to  development. 

The  germ  -  cell,  though  single,  is  compounded  of  the 
union  of  two  cells,  one  from  a  male  and  the  other  from  a 
female,*  and  as  each  of  these  is,  as  is  every  cell  in  a  living 
body,  an  integral  part  of  the  whole  structure  whence  it 
came,  sharing  with  all  its  other  cells  in  the  common  food- 
supply  and  the  special  peculiarities  of  the  body,  it  is 
scarcely  a  matter  of  wonder  that  the  human  offspring, 
which  is  but  a  developed  germ-cell,  should  bear  a  struc- 
ture and  a  character  which  are  blends,  in  varying  propor- 
tions, of  those  of  its  two  parents. 

The  peculiarity  of  structure  transmitted  by  the  parents  is 
thus  the  first  great  determining  factor  in  development,  and 
the  second  and  only  other  is  the  influence  of  the  environ- 
ment. To  turn  for  a  moment  to  a  practical  example  :  a 
specially  unfavorable  environment  may  produce  gout  (or 

*  It  is  probably  the  union  of  the  two  which  starts  the  chemical 
processes  of  growth  and  life. 


12  THE    PRINCIPLES    OF    LIFE. 

any  other  peculiarity)  in  an  individual  free  from  any  he- 
reditary taint,  while  a  specially  favorable  one  may  keep 
the  disease  at  bay,  though  the  structural  tendency  thereto 
may  have  been  strong  in  the  germ-cell. 

The  environment  of  the  germ-cell  and  of  its  offspring 
then  include  the  following  : 

In  the  first  place,  food,  i.  e.,  tissue-food,  technically  called 
albumen,  derived  from  the  organic  parts  of  animals  and 
plants,  and,  after  digestion  —  which  is  synonymous  with 
conversion  to  the  crystalloid  state — presented  to  the  cells. 
In  the  next  place,  all  other  forces  in  Nature  which  have 
an  influence  on  the  rate  and  direction  of  cell-growth.  Of 
these,  fuel  -  food  is,  of  course,  one  of  the  principal,  the 
others  being  certain  conditions  of  air  and  temperature 
favorable  or  the  reverse  to  a  due  activity  in  the  cells  or 
in  certain  of  them,  the  nature  and  extent  of  the  life-work, 
the  influence  of  improper  articles  of  consumption,  all  of 
which,  with  the  host  of  other  influences,  direct  the  course 
of  the  cell-growth — in  other  words,  mould  the  man. 

As  we  shall  see  in  the  next  chapter,  it  is  on  the  adapta- 
bility of  the  environment  to  the  cell  powers  that  health  de- 
pends, an  imperfect  adaptation  inducing  the  phenomena 
of  ill-health,  a  failure  of  adaptation  involving  death. 

And  as  the  body  grows  older  death  must  become  nearer, 
must,  other  things  being  equal,  be  more  easily  induced,  for 
the  growth  power  originally  possessed  by  the  germ-cell, 
and  now  spread  over  all  its  family,  approaches  day  by  day 
nearer  to  exhaustion.  At  conception  its  action  is  rapid, 
doubling,  but  always  with  increasing  intervals,  the  body 
weights  ;  in  middle  life  it  but  suffices  to  enable  the  cells  to 
hold  their  own  ;  in  old  age  even  this  mere  repairing  power 
dwindles.  As  it  is  on  this  store  of  energy,  on  this  grow- 
ing and  repairing  power,  that  life  depends,  so  it  is  on  its 
extinction,  either  ])y  ])remature  destruction  of  the  body 


FUEL-FOODS    THE    SOURCE  OF  MOTOR  POWER.  13 

or  as  the  result  of  a  natural  exhaustion,  that  death  must 
ensue.* 

We  have  so  far  discussed  the  questions  of  growth  and 
development ;  we  now  turn  to  the  discovery  of  the  source 
of  motive-power  in  the  body  of  man.  This  cannot  be  in- 
cluded in  growth,  for  the  processes  I  have  described  so  far 
account  only  for  the  building  up  of  the  body,  the  making 
of  the  mechanism  in  which,  as  in  a  steam-engine,  fuel  may 
be  burned  so  as  to  produce  movement. 

The  fuels  used  by  the  body  of  man  are  of  two  kinds,  fats 
(hydro-carbons)  and  starches  or  sugars  (carbo-hydrates). 
These  are  called  fuel-foods,  and  the  sole  end  in  their  con- 
sumption is  the  production  of  heat-energy.  By  what  proc- 
ess is  this  effected  ? 

Consumed  generally  in  colloid  form,  fuel-foods  are  con- 
verted by  digestion  to  crystalloids,  which,  by  means  of  the 
fluids  in  the  body  (the  origin  of  which  is  the  water  we  im- 
bibe), are  carried  through  the  stomach  and  intestinal  walls 
into  the  blood-current  of  man  and  away  to  his  cells.  Here 
they  are  oxidized  by  means  of  the  oxygen  in  the  blood- 
currents,  the  products  of  the  process,  carbonic  acid  and 
water,  being  expelled  by  the  lungs,  skin,  and  kidneys,  the 
heat-energy  evolved  being  stored  in  the  cells  to  provide 

*  That  the  principles  of  growth  and  life  are  what  I  have  stated, 
phenomena  attendant  on  a  series  of  chemical  actions  between  living 
cells  and  certain  foods,  is  rendered  all  the  more  convincing  by  the 
fact  that,  in  certain  lowly  forms  of  existence,  life  may  be  arrested, 
even  in  the  presence  of  food,  by  dryness  and  cold  (warmth  and  mois- 
ture being  necessary  for  vital  as  for  nearly  all  chemical  processes), 
and  may  be  resumed,  after  a  long  lapse  of  time,  at  the  point  where 
it  left  off,  upon  the  supplying  of  the  two  requisite  conditions.  That 
this  state  of  suspended  animation  cannot  be  reproduced  in  man  is, 
we  may  fairly  presume,  due  to  the  great  complexity  of  his  structure 
and  the  difficulty  of  applying  simultaneously  to  all  parts  the  condi- 
tions necessary  thereto. 


14  THE    PRINCIPLES    OF    LIFE. 

the  body  with  all  its  necessary  movements.  "  Observe," 
says  Sir  W.  Armstrong,  in  comparing  the  body  to  a  steam- 
engine,  "  how  su23erior  the  result  is  in  Nature's  engine  to 
what  it  is  in  ours.  Nature  only  uses  heat  of  low  grade, 
such  as  we  find  wholly  unavailable.  We  reject  our  steam 
as  useless  at  a  temperature  which  would  cook  the  animal 
substances,  while  Nature  works  with  a  heat  so  mild  as  not 
to  hurt  the  most  delicate  tissue.  And  yet,  notwithstanding 
the  greater  availability  of  high  -  grade  temperature,  the 
quantity  of  work  performed  by  the  living  engine,  relative 
to  the  fuel  consumed,  puts  the  steam-engine  to  shame." 

We  have  now  finished  our  task — the  brief  discussion  of 
the  principles  of  life  ;  and  have  made  out  a  case  for  the 
literal  truth  of  the  text  which  heads  this  chapter,  and 
which  we  set  ourselves  to  prove.  From  conception  to 
final  dissolution  man  is  never  anything  but  dust,  for  a 
short  time  a  complex,  organic  dust,  possessed,  under  cer- 
tain conditions,  of  building  power,  and,  supported  by  the 
energies  of  fuel-foods,  evincing  the  signs  of  life,  at  last 
simple  and  powerless  because  it  has  reached  the  general 
low  level  of  inorganic  matter. 

But  the  body  of  man  being  of  the  nature  of  a  machine 
designed  for  motion,  and  being  worked,  like  most  of  our 
machines,  by  heat-energy,  it  is  necessary,  ere  we  close  this 
chapter,  to  show  in  what  way  his  organs  are  ranged  to  ful- 
fil the  necessary  purj^oses  of  machinery,  more  especially  as 
that  arrangement  is  not  at  first  sight  very  clear.  We  maj", 
then,  class  the  organs  thus  into  systems  : 

Tlie  Food  System. 

(a)  Organs  concerned  in  food  reception  :  the  mouth, 
stomach,  and  intestines. 

(h)  Organs  concerned  in  food  digestion — in  the  conver- 
sion of  colloids  to  crystalloids  :    the  mouth  and  its  glands, 


THE    FOOD    AND    NERVOUS    SYSTEMS.  15 

the  stomacli  and  its  glands,  the  intestine  and  its  glands,  the 
liver,  the  pancreas. 

(c)  Organs  concerned  in  pumping  and  conveying  food 
to  the  cells  :  the  heart,  arteries,  and  capillaries. 

(cT)  Organs  concerned  in  the  conveyance  away  from  the 
cells  of  waste  products  :  the  capillaries,  veins  (except  the 
portal  vein),  the  lymphatic  spaces,  glands,  and  ducts. 

(e)  Organs  concerned  in  the  ejection  from  the  body  of 
the  waste  products  of  combustion  or  other  chemical  proc- 
ess :  the  kidneys,  urinary  bladder,  liver,  skin,  and  lungs. 

The  bowel  may  be  included  under  this  heading,  though 
its  function  is  very  different  to  that  of  the  organs  just 
named,  for  it  ejects  from  the  body  material  unsuited  to  its 
nourishment,  and  all  food  in  excess  of  the  digestive  capac- 
ity, material  that  has  never  entered  the  blood-stream  at  all. 

(/)  Organs  concerned  in  the  supply  of  oxygen  :  the 
lunorg. 

(g)  Organs  concerned  in  the  conveyance  of  oxygen  :  the 
red-blood  corpuscles,  the  arteries,  and  the  capillaries. 

In  the  above  list  we  have,  in  the  recurrence  of  some 
organs — e.g.,  the  liver,  the  arteries,  etc. — under  more  than 
one  heading,  an  instructive  example  of  the  economy  prac- 
tised in  the  human  body.  Man  is  thus  not  only  a  machine, 
but  the  best  example  we  have  of  a  perfect  machine,  one 
in  which  every  particle  of  energy  is  utilized  to  the  fullest 
extent.  This  perfection,  say  the  evolutionists,  is  the  neces- 
sary outcome  of  the  fierce  struggle  for  existence  on  this 
globe,  the  survivors  being  those  fittest,  by  reason  of  a 
greater  structural  perfection,  to  live,  and  these  transmit- 
ting onwards  their  special  characteristics. 

The  Nervous  System. 

{a)  Organs  concerned  in  storage  of  nerve  force  :  the 
nerve  cells. 


16  TFIE    PRINCIPLES    OF    LIFE. 

(b)  Organs  concerned  in  the  transmission  of  impressions 
to  or  from  nerve  cells  :  the  nerve  fibres. 

The  nerve  cells  are  probably  batteries,  the  electrical 
energy  which  they  store  being  derived,  by  conversion, 
from  the  heat-energy  evolved  in  the  combustion  of  fuel 
foods.  The  impressions  from  the  outside  world,  and  those 
from  the  interior  of  the  body,  travelling  along  sensory  or 
afferent  (ad,  to,  and/ero,  I  carry)  nerves  to  the  cells,  cause 
an  emission  of  electric  energy  along  the  motor  or  efferent 
{e,  from,  and  fer^o,  I  carry)  fibres  which  pass  from  each 
cell,  and  thus  give  rise,  by  means  hereafter  to  be  more 
fully  described,  to  the  various  movements  of  the  body  or 
to  the  necessary  secretions  and  muscular  movements  of 
internal  organs. 

All  the  reins,  so  to  speak,  of  this  great  guiding  system, 
are  gathered  up  within  the  brain,  in  the  hands  of  what 
may  be  styled  the  driver,  the  "  control  centre,"  there,  the 
seat  of  what  De  Balzac,  in  one  of  his  philosophical  treat- 
ises,* calls  the  vouloir  and  the  2^ouvoir.  Nevertheless, 
even  this  supreme  ruler  depends,  as  abjectly  as  does  the 
lowliest  of  body-cells,  for  the  performance  of  its  high  func- 
tion, on  the  perfection  of  the  alimentary  system  of  supply. 

The  Mot 07'  System, 

{a)  Oi-gans  concerned  in  the  storage  of  heat-energy  :  the 
cells  of  the  body. 

(h)  Organs  concerned  in  locomotion  :  the  bones,  joints, 
muscles,  tendons,  and  ligaments. 

The  principle  employed  in  the  movements  of  the  limbs 
is  that  of  the  lever,  the  joints  act  as  the  fulcra,  the  limbs 
as  the  weights,  and  the  great  masses  of  elongated  cells 
called  the  muscles,  supply,  by  their  contraction,  the  power. 

*  "  La  Peau  de  Cha2;nn." 


THE    REPRODUCTIVE    SYSTEM.  17 

The  Reprodiictwe  System. 

About  this  system  it  is  only  necessary  at  present  to  say 
that,  alone  of  all  the  systems,  its  exercise  is  not  necessary 
to  perfect  health.  In  fact,  this  system  belongs  to  the  race 
rather  than  to  the  individual. 

On  reviewing  my  very  brief  outline  of  the  systems,  one 
is  struck  irresistibly  with  the  prominent  place  occupied  by 
the  alimentary  one.  In  point  of  fact,  it  is  the  only  real 
system,  the  nervous,  motor,  and  reproductive  systems  be- 
ing but  specialized  branches  of  it,  that  convert  and  utilize 
in  various  ways  the  forces  it  supplies. 

To  conclude,  in  dealing  with  what  has  always  been 
viewed  as  the  mystery  of  life  as  explicable  on  a  physical 
basis,  and  in  tracing  the  rationalia  of  its  phenomena,  I 
must  not,  because  I  discard  such  phraseology  as  "  the  lab- 
oratory of  Nature  "  and  "  the  vital  flame,"  vague,  mean- 
ingless, and  pseudo-reverential  terms,  with  which  popular 
books  on  man  so  frequently  teem,  be  held  to  favor  what  is 
called  a  materialistic,  an  atheistic,  view  of  creation ;  for  let 
science  do  what  it  may,  let  it  even  create  from  inorganic 
matter  living  forms,  still  all  that  it  could  then  claim  would 
be  that  it  had  put  together  symbols — matter  and  energy — 
to  form  more  compound  formulae,  more  active  matter,  with- 
out being  able  to  explain  the  essence,  the  nature,  or  even 
the  existence,  as  such,  of  the  materials  with  which  it  had 
worked.  Human  reason  would  still  have  to  face  that 
enormous  chasm  which  separates  its  little  knowable  from 
the  vast  unknowable,  over  which  faith,  resting  on  Divine 
inspiration,  must  still,  and  ever,  reign  supreme. 


CHAPTER  11. 

THE  PRINCIPLES  OF  HEALTH. 

Health,  a  stale  of  unstable  equilibrium  between  tbe  body  of  man 
and  bis  environment,  in  some  striking  points  comparable  to 
the  rhythmic  movement  of  clockwork.  Since  all  men  differ 
in  structure,  no  one  set  standard  environment  can  exist  for  all. 
As  there  is  no  essentially  perfect  environment,  so  can  there 
exist  no  essentially  evil  one.  Within  certain  limits,  and  pro- 
vided the  change  be  gradually  effected,  the  human  body  can 
adapt  itself  to  new  "aggregates  of  force."  Examples  of  this. 
Conclusion. 


CHAPTER  11. 

THE   PRINCIPLES  OF  HEALTH. 

**In  every  aggregate  having  compoiincl  movements,  there  tends  con- 
stantly to  be  established  a  moving  equilibrium,  .  .  .  and  the  standard 
reached  mast  be  one  presenting  an  arrangement  of  forces  that  counter- 
balance all  the  forces  to  which  the  aggregate  is  subject." — Herbert 
Spencer. 

"  Jupiter,  c'est  la  nature  et  le  systeme  qui  la  conduit.  Ce  S3-steme  a 
pour  but  de  tenir  tout  en  mouvement  et  ccpendant  tout  eyi  equilibre.''^ — Ed. 

AUBER. 

The  above  two  quotations  contain  not  only  the  key  to 
the  definition  and  to  the  easy  comprehension  of  the  condi- 
tion called  health,  but,  when  subjected  to  careful  thought, 
will  be  found  later  on  to  furnish  us  w^ith  a  standpoint 
from  which  we  can  discern  the  land  of  scientific  and  nat- 
ural medicine. 

We  have  finished  with  the  question  of  the  construction 
of  man,  and  henceforth  we  have  to  regard  him  as  a  com- 
plete being,  a  single  entity.  Apparently  a  country  of  in- 
numerable independent  cells, in  reality  rather  one  huge  cell 
divided  into  numerous  parts,  each  one  of  w^iich  is  in  more 
intimate  union  with  all  the  others  than  are  the  portions  of 
even  the  most  homogeneous  solid  ;  the  cells  themselves 
aggregated  in  groups  or  organs  by  reason  of  that  external 
and  internal  moulding  through  which  in  their  earlier  his- 
tory they  have  passed,  each  group  differing  consequently 
from  other  groups  in  structure,  and  therefore  perforce  also 
in  function — which  in  all  chemical  compounds  depends  on 
structure — we  have  represented  in  this  composite  being  an 


22  THE    PRINCIPLES    OF    HEALTH. 

embodiment  of  different  forces,  latent  chemical  force,  their 
heritage,  in  his  cells,  and  acquired  heat-energy  derived  from 
the  combustion  of  his  fuel  food. 

To  avoid  the  cumbrous  idea  of  such  an  embodied  mass 
of  ever-varying  quantities  and  arrangements  of  force,  we 
may  conveniently  adopt  Mr.  Herbert  Spencer's  phraseology 
and  speak  of  it  as  the  "aggregate  of  forces"  in  the. body. 
In  the  same  way  may  we,  in  one  single  expression,  sum  up 
the  forces  of  Nature  —  those  resident  in  food,  air,  etc.^ — • 
wdiich  can  act  on  the  body,  speaking  of  them  as  the  "ag- 
gregate of  forces  "  in  the  environment. 

Health  consists  in  the  existence  of  a  state  of  unstable 
equilibrimn  between  these  tioo  aggregates. 

The  term  unstable  equilibrium  may,  in  the  case  of  readers 
who  are  not  familiar  with  this  term  in  physics,  be  best  ex- 
plained by  an  example  from  every-day  life,  that  of  the 
pendulum. 

A  pendulum  is  set  and  kept  in  movement  for  a  fixed 
period  of  time  by  the  expenditure  of  a  small  amount  of 
energy  derived  from  a  coiled  steel  spring,  or  a  slowly  fall- 
ing weight,  and  oscillates  rhythmically  about  its  position 
of  stable  equilibrium,  maintaining  the  clock  mechanism,  to 
which  it  is  attached,  in  regular  action.  This  is  an  example 
of  imstable  equilibrium  ;  the  pendulum  is,  as  it  were,  con- 
stantly seeking  to  come  to  rest  in  the  position  of  stable 
equilibrium  (that  assumed  by  it  when  the  clock  is  not  go- 
ing), and  is  constantly,  but  with  great  regularity,  over- 
shooting the  mark,  by  reason  of  the  energy  resident  in 
the  mainspring  or  elevated  clock-weight. 

It  is  precisely  thus  with  man's  body.  The  energy  that 
maintains  in  it  those  rhythmic,  regular  movements  of 
health  which  are  essential  to  life — breathing,  heart-pulsa- 
tion, etc.  —  and  which  correspond  to  the  oscillation  of 
the  pendulum,  is  derived  from  the  latent  energy  in  the 


ALL   HEALTH    STANDAEDS    FALLACIOUS.  23 

body  cells  which  acts  on  it,  and  in  the  energies  resident  in 
food,  etc. 

In  some  of  the  lowliest  forms  of  life,  for  example,  in 
some  fever  germs,  we  may  witness  examples  of  the  exist- 
ence of  a  stable  equilibrium  between  the  two  aggregates 
of  force.  In  such  cases  there  results  a  suspension  of  life, 
animation  beingf  only  resumed  when  an  increase  in  heat, 
moisture,  or  other  environing  force,  again  disturbs  the  ab- 
solute stability  of  the  balance  and  restores  the  vital  phe- 
nomena. In  hibernating  animals  we  witness  a  near  ap- 
proach to  the  same  state. 

Mr.  Herbert  Spencer  calls  unstable  equilibrium,  as  wit- 
nessed in  human  beings,  "  moving  equilibrium,"  a  term 
which  he  makes  to  include  more  facts,  but  still  all  mider 
the  one  and  same  principle. 

In  the  case  of  various  clocks,  it  matters  not  a  jot,  as  far 
as  the  main  object  of  clockwork  is  concerned — the  correct 
indication  of  time  for  a  certain  period — whether  the  pen- 
dulum be  large  or  small,  heavy  or  light,  or  whether  its 
oscillations  extend  over  three  or  three  dozen  inches.  It  is 
also  so  with  man.  As  regards  his  health,  the  question  of 
muscular  strength,  of  girth  of  chest,  of  size,  has  naught 
to  do  with  health,  the  sole  test  being  the  adaptability  of 
the  body  to  continue  under  the  circumstances  of  life  in 
ichich  it  is  placed — i.e.,  under  its  environment  —  in  those 
regular  rhythmic  movements  ichich  are  most  conducive  to 
a  long  life. 

It  follows  as  a  necessary  corollary  that  there  can  be  no 
general  arbitrary  standards  such  as  our  one-idea  men  are 
so  fond  of  assuming,  no  one  perfect  diet,  no  one  perfect 
mode  of  life,  no  one  fixed  amount  of  ozone  in  the  air, 
which  would,  liad  man  but  the  grace  to  follow  their  wise 
counsels,  regenerate  mankind,  and  make  all  men  healthy, 
wealthy,  and  wise  ;  and  that  no  one  fixed  combination  of 


24  THE    PEIXCIPLES    OF    HEALTH. 

these  would,  or  could,  ever  suffice  to  that  end  ;  and  this 
simply  because,  as  no  two  men  coincide  jDrecisel}'  in  con- 
struction and  in  the  amount,  variety,  and  distribution  of 
forces  within  the  body,  no  one  set  of  conditions  can  pos- 
sibly be  adaptable  to  the  whole  mass  of  humanit3\ 

I  used  to  wonder  at  one  time  why  Providence  was  so 
unkind  to  the  very  amiable,  but  usually  in  general  matters 
a  little  myopic,  theorists,  diet-men,  teetotallers,  faith -heal- 
ers, anti  -  tobacconists,  hygienists,  etc.  One  read  their 
books,  their  arguments  seemed  powerful,  but  the  success 
anticipated  did  not  somehow  attend  the  adoption  of  their 
principles.  Kow  vre  know  the  reason  of  this.  These  lim- 
pets had  grasped  the  rock  of  knowledge,  but  covered  only 
a  portion  of  it  with  their  shells,  refusing  to  believe  that 
there  existed  anything  beyond  that  narrow  boundary-line. 

To  return  to  our  subject.  We  have  thus  two  "aggre- 
gates of  forces  " — in  other  words,  two  compound  bodies — 
each  possessed  of  many  different  forms  of  force,  the  one 
the  human  body,  the  other  the  environment  of  that  body. 
The  first  has  to  undergo  moulding,  the  second  is  the 
mould,  or,  to  speak  more  correctly,  both  modeller  and 
mould. 

The  peculiar  plasticity  of  the  human  body,  its  adapta- 
bility therefore  to  undergo  change  of  form,  and  even  of 
internal  construction,  in  obedience  to  force  majeure,  acting 
in  the  nature  of  a  mould  on  both  the  interior  and  the  ex- 
terior of  its  constituent  cells,  we  have  studied  in  the  last 
chapter.  The  structure  of  the  mould  is  familiar  to  all  of 
us ;  it  is  both  many-sided  and  infinite  in  the  variations  of 
force  exerted  by  its  different  parts.  Food,  light,  air, 
sound — in  short,  contact  with  multiform  bodies  of  incon- 
stant shape,  density,  and  power,  acting  sometimes  in  one 
way  and  with  one  intensity,  sometimes  in  a  precisely  op- 
posite manner  and  with  greater  or  less  force,  sometimes 


ALL    HEALTH    STANDARDS    FALLACIOUS.  25 

affecting  one  part  of  the  body,  sometimes  another,  and 
sometimes  acting  simultaneously  and  with  equal  pressure 
on  all  sides.     Such  is  the  environment,  the  mould  of  man. 

I  will  give  an  illustration  of  my  subject.  Some  years 
ago  a  medical  scientist  of  no  mean  repute  invented  a  ma- 
chine that  registered  almost  everything  a  man  ought  to  do 
— how  deeply  he  ought  to  breathe,  how  often  and  how 
rhythmically  his  heart  ought  to  beat,  what  ought  to  be 
the  amount  of  power  in  his  biceps,  how  much  he  ought  to 
weigh,  and  a  host  of  other  things.  Two  friends  of  mine, 
of  nearly  equal  age  —  the  one  a  young  medical  man  of 
Highland  parentage ;  the  second,  in  the  same  profession, 
but  born  within  the  sound  of  Bow  Bells — submitted  them- 
selves to  this  machine,  which  was  to  tell  them,  barringf 
unforeseen  circumstances,  such  as  violent  death,  etc., 
their  chances  of  life,  and  their  actual  existing  state  of 
health.  The  Highlander's  state  of  health  was  declared  to 
be  of  the  finest,  and  nearly  a  half-century  of  life  was  pre- 
sented to  him  by  his  mechanical  judge,  while  the  poor 
Londoner  was  practically  sentenced  to  death,  and  that 
with  such  promptitude  that  one  felt  prompted  to  suggest 
to  the  delighted  scientist — he  was  delighted  with  the  per- 
fection of  his  machine  ;  he  did  not  seem  to  notice  or  care 
much  about  the  effect  on  human  feeling  of  its  awards — 
that  an  additional  mechanism  by  which  in  similar  cases 
a  small  black  cap  might  be  assumed  by  the  machine  would 
be  a  suitable  and,  for  the  onlookers,  even  an  attractive,  ad- 
dition. Both  my  friends  remained  in  London,  and  worked 
under  similar  conditions.  The  Highlander  contracted 
phthisis  and  died  in  a  little  over  a  year ;  the  Londoner 
lives,  and  is  contemplating  marriage  instead  of  burial. 

This,  the  reader  may  say,  was  a  coincidence.  Unfortu- 
nately, examples  of  its  being  a  general  law  are  forthcom- 
ing in  plent3^  When  the  vigorous  mountaineer  enters  the 
2 


26  THE    PRINCIPLES    OF    HEALTH. 

police  force  of  Glasgow  or  London  he  runs  a  chance  of 
dying — generally  of  consumption,  the  death  of  the  weak- 
ling— infinitely  greater  than  does  the  puny  "  Glesca  chap- 
pie "  or  Cockney,  who  has  such  difficulty  in  passing  the 
doctor.  The  Highlander  has  a  splendid  physique,  but  a 
physique  which  demands  certain  conditional  surroundings. 
The  relatively  impure  air  of  large  towns  acts  as  a  poison 
on  him  ;  the  contrast  is  too  great  for  his  body;  no  bal- 
ancing is,  in  many  cases,  possible,  and  the  Highlander 
simply  succumbs,  and  the  more  vigorous  he  is,  the  more 
swiftly  and  surely,  other  conditions  being  equal,  will  he 
fail  and  die.  If  a  change  of  environment  has  to  be  made, 
it  should  be  made  gradually,  so  that  the  strain  thrown  on 
the  body  in  its  effort  to  balance  should  be  spread  over  as 
long  a  time  as  possible,  and  thus  that  its  effects  may  be 
modified  ;  for,  as  we  shall  see  in  the  next  chapter,  if  a 
body  cannot  balance  the  incident  aggregate  of  forces  in 
obedience  to  phj^sical  laws,  it  must  undergo  certain  retro- 
grade changes  which  jeopardize  its  life. 

That  which  is  seen  in  the  case  of  the  Highlander  is  wit- 
nessed equally  when  the  town  youth  suddenly  changes  to 
a  cold  mountain  climate.  If  his  body  be  not  capable  of 
rapidly  balancing  the  altered  forces  with  which  it  is 
brought  in  contact,  he  will  either  die  himself,  or,  if  mated 
with  a  woman  of  similar  constitution,  be  unable  to  per- 
petuate his  race  ;  for  the  failure  to  balance,  when  but 
slight,  is  manifested  in  the  descendants.  We  have  exam- 
ples of  this  in  Anglo-Indians.  They  are  often  picked 
men,  and  their  wives  are,  as  a  rule,  specimens  of  vigorous 
British  womanhood,  and  yet  the  children  are  weak  and 
puny,  and  the  country  cannot  be  colonized.  Even  when 
the  Englishman  intermarries  with  the  native  race  the  re- 
sulting progeny  is  not  as  well  fitted  to  fight  the  battle  of 
existence  as  is  the  native  youth,  though  physically  the 


THE  ADAPTATION  OF  MAN  TO  HIS  SUEKOUNDINGS.       27 

half-caste  is  generally  mucli  the  better  man  ;  but  physique 
—  the  common  ideal  of  physique  —  has,  as  I  have  said, 
nothing  to  do  with  health  unless  it  happen  to  be  in  bal- 
ance with  the  general  average  conditions  of  life  of  the 
individual. 

But  in  nothino;  better  than  in  disease  are  we  furnished 
with  striking  examples  of  the  power  that  the  average  man 
of  a  country  possesses  to  balance  the  average  forces  there- 
of. The  Englishman  scarcely  dreads  measles  ;  it  has  for 
centuries  been  so  familiar  a  disorder  as  almost  to  constitute 
a  factor  in  the  aggregate  of  forces  of  his  environment ;  in 
fact,  is  one,  to  an  extent  proportioned  to  its  frequency, 
and  it  was  naturally  thought,  and  therefore  confidently 
asserted,  by  him — for  he  judged  only  by  his  own  experi- 
ence, as  we  all  do — to  be  a  comparatively  harmless  disease, 
caused  by  a  bacterium  of  feeble  power.  But  when  carried 
by  an  English  ship  to  the  Fijians,  it  became  to  them  a  fa- 
tal and  malignant  scourge.  This  result  gave  rise  to  the 
penning  of  much  scientific  nonsense.  One  man  said  that 
this  was  so  because  the  Fijian  was  black  ;  another,  be- 
cause his  climate  acted  as  a  kind  of  hot-house  for  the  bac- 
terium ;  others  saw  the  causation  in  faults  in  his  dietary  ; 
while  one  or  two  ecclesiastics  developed  the  idea  that, 
with  the  British  missionary,  God  had  instituted  the  Euro- 
pean moral  code  in  Fiji,  and  that  the  appearance  of  this 
scourge  was  designed  by  Heaven  to  show  the  native  that 
the  Almighty  would  not,  now  that  he  had  means  of  en- 
lightenment, tolerate  his  little  "goings  on"  with  impuni- 
ty. However,  as  Christian  blacks  died  in  the  same  ratio 
as  their  heathen  brothers,  the  latter  theory  had  to  be 
dropped,  lest  the  profane  might  have  argued  from  it  that 
Christianity  was  not,  in  divine  eyes,  such  a  great  improve- 
ment on  the  moral  statics  quo  ante.  The  real  cause  of  this 
unexpected  virulence  of  a  mild  European  disease  lay  in  the 


28  THE    PRINCIPLES    OF    HEALTH. 

simple  fact  that  measles  represented  to  the  Fijian  man's 
body  a  force  which  he  had  no  means  of  balancing,  it  being 
utterly  unlike  any  force  to  which  it  Avas  habituated.    There 
is  thus  in  these  diseases  no  rigid  standard  of  viridence, 
everything  depending  upon  the  special  adaptability  of  the 
body.     It  is  thus  with  scarlet  fever  and  with  small-pox, 
whose  violence,  without  any  reference  to  sanitation,  is  in- 
finitely greater  among  black  races  than  with  us.    There  are 
cases  on  record  where  the  black  races  have  returned  us 
this  compliment.     Cholera  has  several  times  visited  our 
shores,  and  proved  more  fatal  to  those  attacked  than  is  the 
same  form  of  cholera  (for  there  are  at  least  two  varieties 
of  cholera)  in  India.     It  is  true  there  is  not  such  a  very 
great  difference  in  the  death-rate  as  in  small-pox,  but  it 
must  be  remembered  that  cholera  is  a  disease  not  quite  new 
to  us,  and  that,  even  in  so-called  English  cholera,  we  pos- 
sess a  form  which,  if  not  due  to  precisely  the  same  genus 
and  species  of  bacterium,  may  reasonably  be  viewed  as 
conferring  on  us   some  immunity,  and  thus  placing  our 
case  and  that  of  the  black  races  more  on  a  par.     Syphilis, 
the  most  fatal  of  all  scourges,  is  believed  by  most  author- 
ities to  have  come  to  us  from  the  New  World.     It  cer- 
tainly first  showed  itself  in  Europe  shortly  after  the  re- 
turn of  Columbus  from  Hayti  in  1493,  and  its  ravages  in 
Europe  were  terrible.     Even  if  not  then  imported  from 
America,  it  was  a  new  disease  in  France,  England,  Spain, 
Italy,  and  Austria,  and  consequently  the  death-rate  from 
it  there  was  enormous.     In  Spain  and  Portugal  it  is  now 
a  mild  complaint,  while  even  in  England  it  is  rarely  or 
never  fatal  in  its  primary  stage,  as  it  used  commonly  to 
be  when  first  imported.     Yellow  fever  again  is  infinitely 
more  fatal  to  the  European,  especially  on  his  first  arrival 
in  the  West  Indies  and  in  tropical  South  America,  than  it 
is  to  the  black  races  resident  there.      Innumerable  in- 


CORRESPONDENCE    WITH    THE    ENVIRONMENT.  29 

stances,  all  proving  the  rule  that  this  capacity  of  the  ag- 
gregate of  forces  in  a  man's  body  to  balance  the  aggregate 
of  the  forces  in  his  environment  is  the  sole  test  of  health 
and  the  great  guarantee  of  life,  could  be  given  ;  and  proofs 
that  the  mind  of  man  is  subject  to  a  similar  law  might 
also  be  adduced,  but  I  have  said  as  much  as  my  space  per- 
mits of,  and  sufficient  to  prove  my  contention. 

But,  may  object  a  dissentient,  how  can  my  body,  or  the 
forces  therein,  balance  the  virus  of  small-pox,  considering 
that  neither  I  nor  any  of  my  predecessors  for  many  gen- 
erations have  had  it?     To  such  I  reply  that  this  disease 
has  existed  in  Europe  for  some  hundreds  of  years,  and 
that  if  the  dissentient  could  trace  back  his  descent  for 
that  period,  he  would  find  that  out  of  his  few  millions  of 
ancestors — direct  and  collateral — there  will  be  found  very 
many  who  have  suffered  from  it.     The  human  race  is  all 
more  or  less  related,  and  the  nineteenth-century  man,  as 
regards  his  bodily  structure,  and  therefore  also  as  regards 
its  functions,  is  really  a  blend  in  varying  proj)ortions  of 
the  innumerable  bodies  of  which  he  is  the  descendant. 
If,  therefore,  small-pox  has  been  for  long  absent  from  the 
immediate  predecessors  of  a  man,  he  runs  a  great  chance 
of  contracting  it  unless  he  has  been  vaccinated — tace^  O 
anti-vaccinationist !     I  have  something  to   say  both  for 
and  against  you,  by  and  by — and  if  he  take  it,  he  Avill 
probably  suffer  from  an  attack  which,  if  his  body  be  not 
in  general  good  order,  may  very  likely  kill  him  ;  but  still 
his  risk  will  be  less  than  that  of  the  negro,  and  that  be- 
cause the  white  man's  not  very  remote  ancestors  have  suf- 
fered from  it,  whereas  the  negro  is  not  thus  protected,  or, 
in  any  case,  not  to  a  similar  extent. 

It  is  undoubtedly  to  the  genius  of  Darwin  that  we  are 
indebted  for  the  most  complete  working  out  of  the  action 
of  this  law  of  correspondence  between  a  body  and  its  en- 


30  THE    PRINCIPLES    OF    HEALTH. 

vironment,  though  Darwin  unfortunately  did  not  attempt 
the  extension  of  it  into  the  reahns  of  disease  ;  and  it  must 
be  remembered  that,  although  many  disagreed  with  his 
conclusions,  because  they  considered  that  these  went  be- 
yond the  logical  power  and  scope  of  his  premises,  yet  no 
one  called  in  question  his  premises,  the  innumerable  ex- 
amples he  cited  of  the  effect  of  the  surroundings  on  a 
structure ;  indeed,  to  have  done  so  would  have  been  to 
deny  the  truth  of  every-day  experience,  and  to  render  im- 
possible the  descent  of  mankind  from  a  single  pair  of  hu- 
man beino:s,  as  related  in  the  Bible.  How  else  could  the 
Chinaman,  the  Papuan,  and  the  Englishman  have  had  a 
common  pair  of  ancestors  if  the  effects  of  their  surround- 
ings had  not,  since  the  creation,  had  a  most  potent,  effect 
on  their  bodily  constitution  ?  We  are,  of  course,  not  con- 
cerned in  this  discussion  with  the  origin  of  man,  or  the 
genesis  of  species ;  we  have  only  to  deal  with  this  com- 
pound being,  the  man  of  to-day,  and  to  view  in  his  imme- 
diate surroundings  the  moulding  process  constantly  at 
work. 

Beware,  then,  of  idealists,  beware  of  standard-mongers. 
The  sole  test  of  health  is  the  power  of  any  given  human 
being  to  balance  the  aggregate  of  the  forces  with  which 
he  may  come  into  contact.  Remember  that  you  are  what 
you  are,  because  of  the  effect  on  you  and  on  your  prede- 
cessors of  a  certain  environment,  and  because  you  are  lit- 
erally, as  I  explained  in  the  first  chapter,  a  grown-up  por- 
tion of  a  father  and  mother,  who  each  in  their  turn  were 
integral  portions  of  their  parents,  and  so  on  back  for  in- 
numerable generations. 

It  is  almost  certain  that,  for  the  same  reasons  as  those 
which  I  have  already  given  for  the  larger  mortality  at- 
tendant on  a  disease  new  to  a  people,  as  com.pared  with 
that  witnessed  in  the  races  accustomed  to  it,  second  at- 


CORRESPOXDENCE    WITH    THE    EXYIROXMEXT.  31 

tacks  of  a  specific  fever  are  rarely  witnessed  in  the  same 
individual,  or  if  a  second  attack  occur,  that  it  is  so  much 
lighter  than  the  first.  Of  course  there  are  other  factors 
concerned  in  some  cases  ;  a  body  may,  for  example,  be  so 
imperfect  as  not  to  be  able  to  balance  the  most  ordinary 
forces,  and,  moreover,  the  special  development  of  the  bac- 
terium and  many  other  considerations  must  be  taken  fairly 
into  account. 

The  beneficial  effects  of  change  of  air  on  a  sick  person 
afford  us  yet  a  further  and  familiar  evidence  of  our  law. 
Is  it  not  a  fact  that  the  tired-out  London  clerk  or  waiter 
often  gets  well  more  quickly  in  his  native  air?  How 
often  do  doctors  smile,  how  often  have  I  not  myself 
smiled,  at  this  apparently  silly  conceit,  this,  as  I  judged, 
superstitious  belief  in  native  air ;  and  how  often  have  I 
not  had  to  confess  that  it  did  seem  to  possess  some  pecul- 
iar virtue  ?  The  solution  of  the  problem  is  easy.  The 
part  of  the  country  Avhere  an  individual  was  brought  up, 
and  which  his  forefathers  had  inhabited,  is  the  part  the 
conditions  of  which  the  deranged  body  of  the  patient  is 
likely  to  most  easily  balance,  and  balance  is  health.  It 
does  not  matter  a  fig  if  the  part  be  not  mentioned  in  the 
ofiScial  catalogue  of  health  resorts,  or  even  if  from  any 
peculiarity,  owing  to  which  its  climate  has  failed  to  come 
up  to  some  artificial  standard  of  moisture  or  of  ozone,  it 
may  have  been  placed  in  the  "  Index  Expurgatorius  "  of 
the  climato-therapeutist,  provided  the  patient's  fathers  en- 
joyed good  health  and  long  life  there,  and  that  he  himself 
was  well  while  living  there,  it  may  generally  with  the  ut- 
most confidence  be  recommended  to  him  if  his  health  has 
been  derano^ed  from  anv  one  of  the  ordinarv  effects  of  a 
town  life. 

Let  us  finallv  brino"  too^ether-the  threads  of  the  aro^ument. 

Health  consists  in  the  existence  of  a  state  of  balance 


32  THE    PRINCIPLES    OF    HEALTH. 

between  man  and  his  surroundings,  the  special  conditions 
of  his  existence.  Man  possesses  the  power  of  altering  his 
environment,  and,  provided  he  inherit  a  fair  structure 
from  his  parents,  the  alterations  be  made  gradually,  and 
his  body  be  fairly  rich  in  its  inherited  energy — the  vital 
cell  energy — in  other  words,  provided  he  be  young,  the 
body  will  become  moulded  to  its  new  conditions,  will  re- 
arrange automatically  its  forces  so  as  to  meet  such  new 
conditions,  without  anything  more  than  the  most  trifling, 
and  often  quite  unnoticed,  disturbance. 

But  these  simple  facts,  so  universally  acknowledged  and 
so  confirmed  by  every-day  experience  as  to  seem  to  render 
quite  superfluous  their  formal  annunciation,  are,  while  in 
theory  held,  in  practice  discarded  by  the  majority  of  phy- 
sicians. Not  in  the  study  of  the  forces  and  powers  of  the 
individual  and  of  those  which  enter  into  his  special  envi- 
ronment— not,  as  we  should  expect,  in  the  careful  weigh- 
ing and  balancing  of  the  one  set  against  the  other  to  dis- 
cover in  what  direction  the  lack  of  adjustment  is  to  be 
sought,  and  how  it  may,  by  readjustment,  be  rectified, 
does  medicine  pride  itself,  but  on  a  silly,  long  since  ex- 
ploded, and  pride-begotten  theory  that  man  is  the  pet  and 
spoiled  child  of  the  earth  ;  that  everything  is  more  or  less 
created  for  his  pleasure  and  his  good;  and  that,  if  these 
latter  desiderata  are  not  obtained  by  him,  as  evidently 
they  are  not,  it  is  simply  because  in  plants,  in  animals, 
and  in  minerals,  the  pearls  of  great  price,  the  heaven-sent 
antidotes  to  his  maladies,  his  pains,  and  his  torments,  have 
not  yet  been  discovered.  With  redoubled  vigor  is  the 
research  pushed,  every  new  chemical  compound,  every 
untried  vegetable  extract,  every  fresh  emulsified  and  di- 
gested animal  compound,  nearly  all  utterly  foreign  to  his 
bodily  needs,  and  therefore  worse  than  useless — even  di- 
rectly harmful — to  his  organization,  all  have  to  be  made 


FALSE,   POPULAR,   THEORIES    ABOUT    DISEASE.  3',i 

trial  of,  and  when,  to  rid  itself  of  these  antagonistic,  be- 
cause unusual  and  unutilizable,  forces,  the  body  calls  up 
its  reserve  forces  to  expel  the  intruder,  by  the  perspira- 
tion, the  urine,  the  saliva,  or  the  bile,  a  paean  of  joy  rises 
from  the  therapeutic  choir,  and  a  new  weapon  against  dis- 
ease is  enrolled  in  the  official  catalos^ue.  What  a  travestv 
of  science  !  AYhat  a  reversal  of  the  common  dictates  of 
our  reason !  A  beneficial  process  (for,  as  we  shall  see  in 
the  next  chapter,  disease  is  a  benefactor)  is  first  mistaken 
for  an  evil,  and  then  a  second  and  real  evil  is,  as  a  general 
rule,  introduced,  in  the  hope  that  in  its  expulsion  the  first 
intruder  may  share. 

But  this  is  not  the  place  to  discuss  the  absurdities  with 
which  the  principles  of  medicine,  when  it  deigns  to  give 
any  indication  of  the  possession  of  any  intelligible  princi- 
ples, abound;  the  question  of  equilibrium  of  health  has  so 
far  alone  demanded  our  attention,  while  in  the  next  chap- 
ter, and  ere  we  can  come  to  the  practical  questions  of 
treatment,  we  must  seek  to  interpret  correctly  the  signifi- 
cance of  what  is  popularly  styled  disease. 
2* 


CHAPTEK  III. 

THE   PRINCIPLES   OF   ILL-HEALTH. 

Ill -health  consists  in  a  disturbance  of  the  equilibrium  of  health. 
The  disturbing  force  may  be  slight  and  the  process  of  re-equi- 
libration (/.  e. afunctional  disorder),  in  consequence,  short  and  re- 
storative of  the  old  state  of  balance  ;  or  more  powerful,  and 
partially  destructive  of  the  body  {i.  e.,  organic  disease'),  with  one 
of  the  following  results  :  either  the  re-establishment  of  an  im- 
perfect equilibrium  {clironic  ill-health),  in  which  the  rhythm  of 
health  is,  more  or  less,  wanting,  and  which  must,  except  under 
special  conditions  of  environment,  end  in  premature  death;  or 
the  more  or  less  sudden,  complete,  and  permanent  overthrow  of 
all  equilibrium  {death').  The  symptoms  of  disease  are  always 
beneficent,  are  the  visible  effects  of  the  excess  (the  disturbing) 
force  expending  itself  on  the  body  in  the  direction  of  the  least 
resistance.  Drugs  may  deflect  the  direction  taken  by  this  force, 
or  may  cause  the  part  attacked  to  liberate  more  of  its  vital  force, 
both  doubtful  benefits;  they  are  impotent  to  check,  to  counter- 
balance, the  real  evil,  the  disturbing  force.  Examples  of  differ- 
ent varieties  of  ill-health. 


CHAPTER  III. 

THE  PRINCIPLES   OF  ILL-HEALTH. 

"  If,  then,  there  exists  this  state  of  equilibrium  amoug  a  definite  set  of 
internal  actions,  exposed  to  a  definite  set  of  external  actions,  what  must 
result  if  any  of  the  external  actions  are  changed?  Of  course  there  is  no 
longer  an  equilibrium.  Some  force  Avhich  the  organism  habitually  gen- 
erates is  too  great  or  too  small  to  balance  some  incident  force ;  and 
hence  arises  a  residuary  force  exerted  by  the  environment  on  the  organ- 
ism or  by  the  organism  on  the  environment.  This  residuary  force — this 
unbalanced  force — of  necessity  expends  itself  in  producing  some  chano-e 
of  state  in  the  organism." — Heebert  Spencer. 

"  Any  fresh  force  brought  to  bear  on  an  aggregate  in  a  state  of  moving 
equilibrium  must  do  one  of  two  things  :  it  must  either  overthrow  the 
moving  equilibrium  altogether,  or  it  must  alter  it  without  overthrowino- 
it;  and  the  alteration  must  end  in  the  establishment  of  a  new  movin"- 
equilibrium.  Hence  in  organisms,  death  or  restoration  of  the  physio- 
logical balance  are  the  only  altei-natives." — Herbert  Spencer, 

"  Telle  est  dans  le  corps  liumain  la  termiuaism  necessaire  de  toute  ma- 
ladie  partielle;  c'est  I'economie  cntiere  qui  seule  pent  la  guerir,  soit  en 
faisant  rentrer  dans  Tequilibre  organique  la  partie  troublee,  soit  lorsque 
cette  partie  n'est  pas  d'importance  majeure,  en  etouffnnt  son  action.  Le 
concert  alors  demeure  incomplet,  mais  puisqu'il  y  a  encore  equilibre 
organique  entre  les  parties  qui  rcstent,  c'est  un  concert  encore."'— Er». 

ArRER. 

"  Katuee,"'  says  Professor  Huxley,  "  is  the  expression 
of  a  definite  order  ^ith  which  nothing  interferes."  In 
this  chapter  we  shall  see  that  order  perv'ades  what,  in  our 
ignorance,  we  are  wont  to  i*gard  as  pre-eminently  the 
realm  of  disorder,  bodily  disease;  and  that  the  symptoms 
attendant  on  loss  of  health  are  merely  phenomena,  the 
necessary  result  of  the  orderly  behavior  of  a  bodv  in  the 
presence  of  unusual  surroundings. 

In  our  last  chapter  we  concluded  that  health  consisted 


38  THE    PRINCIPLES    OF    ILL-HEALTH. 

in  the  existence  of  a  condition  of  equilibrium  between  two 
aggregates  of  force,  the  one  representing  the  body,  the 
other  its  surroundings,  its  environment.  To  adopt  an- 
other phraseology,  we  may  define  a  condition  of  health  as 
a  "correspondence  with  the  environment." 

Xow,  keeping  our  eyes  still  upon  the  recognized  laws  of 
physics,  let  us  ask  ourselves  what  are  the  consequences  of 
a  disturbance  of  a  condition  of  equilibrium,  either  of  the 
stable  or  of  the  unstable  kind  ? 

And  we  will  answer  the  question  by  selecting  a  homely 
example. 

At  Tunbrids^e  Wells  there  is  a  larsre  stone  called  the 
Toad  Rock,  which,  under  ordinary  conditions,  though  rest- 
ing on  a  comparatively  narrow  base,  remains  upright  and 
motionless.  It  is  immobile,  because  it  is  in  a  condition  of 
stable  equilibrium,  the  force  of  gravity  which  would  urge 
it  downwards  being  counterbalanced  by  accurate  adjust- 
ment of  adverse  forces.  But  if  there  be  brought  to  bear 
on  this  poised  stone  a  side  pressure,  it  will  be  made  to 
sway  backwards  and  forwards  for  a  short  time,  after 
which  it  resumes  its  former  position  and  its  original  im- 
mobility. 

But  suppose  a  stronger  force  act  upon  it,  suppose  that  a 
larsre  bullet  be  fired  ao;ainst  it  so  as  to  dislodcre  a  mass,  sav 
of  two  or  three  pounds'  weight.  In  such  a  case  the  rock 
will,  after  swaying,  again  become  motionless,  but  now  the 
equilibrium  w^U  no  longer  be  perfect,  and  any,  even  com- 
paratively small,  fresh  amount  of  force  exerted  on  it, 
while  producing  a  sw^aying  as  heretofore,  will  seriously 
jeopardize  its  position. 

Biit,  thirdly,  if,  instead  of  a  bullet,  a  cannon-ball  were 
to  strike  it,  or  some  other  very  great  force  were  brought 
to  bear  on  it  :  in  such  a  case  the  equilibrium  would  no 
longer  be  perfect  or  imperfect,  for  the  rock  would  be  sim- 


THE    TWO    VARIETIES    OF    ILL-IIEALTII.  39 

ply  overthrown,  either  because  too  large  a  portion  of  one 
side  was  knocked  away,  or  because  the  whole  mass  was 
bodily  forced  over  or  shattered;  in  either  case,  its  original 
poised  position  would  be  lost  to  it  forever. 

And  what  is  true  of  the  Toad  Rock  and  of  conditions 
of  stable  equilibrium  in  general,  is  equally  so  of  unstable 
equilibrium.  There  are  only  three  possible  results  as  a 
consequence  of  disturbance  by  unusual  force.  In  a  pen- 
dulum, for  example,  we  shall  have  an  excess  of  movement 
to  counterbalance  the  excess  of  force,  and  then  restoration 
of  the  old  order  of  things;  or  we  shall  have  such  exces- 
sive movement  accompanied  by  a  partial  destruction  of 
the  pendulum  ending  in  an  unsatisfactory,  albeit  still  reg- 
ular, set  of  oscillations  which  will  not  be  productive  of 
accurate  time-keeping,  and  which  will  bring  the  clock- 
mechanism,  by  a  few  minutes  or  hours,  according  to  the 
damage  done,  prematurely  to  a  stop;  or,  finally,  we  shall 
witness,  as  a  result  of  a  yet  greater  force,  a  complete  and 
sudden  arrest  of  all  movement. 

Let  us  apply  our  principle  to  man.  In  health  his  body 
is  in  a  condition  of  unstable,  of  moving,  equilibrium  with 
its  conditions  of  life. 

Let  the  balance  be  disturbed  by  a  trifling  lack  or  excess 
in  either  factor  of  the  balance — for  in  both  cases  the  re- 
sult will  be  the  same — and  we  witness  in  him  the  symp- 
toms of  ill-health,  of  derangement,  just  as  we  do  in  the 
clock  pendulum.  The  rhythm  of  the  vital  movements — 
one  or  all — is  disturbed.  The  breathing-power,  the  heart- 
beat, the  regularity  of  thought,  some  or  all  the  ordinary 
sensations  of  health,  undergo  variation.  By  and  by,  if 
the  action  of  the  excess  force,  be  it  in  the  shape  of  a  fever 
germ,  or  of  an  unwonted  exposure  to  a  low  temj^erature, 
or  even  of  exposure  to  the  ordinary  conditions  of  life 
when  the  bodily  vigor  is  depressed  by  want  of  food,  be 


40  THE    PRINCIPLES    OF    ILL-HEALTH. 

removed,  complete  health  returns,  and  we  say  that  the  pa- 
tient has  been  suffering  from  Sl  functional  disorder. 

But  suppose  the  excess  force  be  of  more  powerful  kind 
— a  potent  fever  germ,  for  example — the  blow  dealt  is 
swift  and  strong.  As  to  the  result  thereof,  much  will  de- 
pend on  the  vigor,  the  amount  of  force  in  the  body  and 
its  availability  to  meet  this  crisis.  If  either  of  the  latter 
are  found  wanting,  then  ^:>«rif^a/  destruction  of  the  body 
will  result.  The  excess  force  having  thus  expended  itself, 
health  returns,  but  a  less  secure  health  than  before,  a  con- 
dition of  body  that,  if  life  is  to  reach  its  natural  term, 
must  have  adapted  to  it  a  special  environment.  This  is 
organic  or  structural  disease. 

Finally,  from  feebleness  of  the  body,  or  from  the  pres- 
ence of  a  very  unusual  force  in  the  environment,  the  com- 
plete and  rapid  overthrow  of  the  body  may  ensue.  This 
is  mortal  disease^  merely  an  advanced  degree  of  organic 
disease. 

Now,  if  the  above  view  of  disordered  action  in  the  hu- 
man body  be  correct — and  let  the  reader  remember  that 
the  principle  it  embodies  is  one  unchallenged  in  physics, 
and  the  application  of  it  to  living  organisms  is  chargeable 
to  no  less  a  scientist  than  Mr.  Herbert  Spencer — it  follows 
of  necessity  that  the  symptoms  of  disease  are  the  efforts  of 
the  bodily  forces  to  attain  re-equilibration  or  health,  and 
must  in  rational  treatment  rather  be  fostered  than  com- 
bated, the  cause  of  their  appearance — the  unusual  force — 
being  the  only  evil  to  be  removed.  Again,  most  heretical 
of  conclusions,  it  will  also  follow  that  symi)toms  cannot 
lead  to  organic  disease,  to  structural  decay,  as  they  are,  by 
even  leading  medical  men,  every  day  asserted  to  do,  for  it 
can  only  be  the  persistence  of  the  cause  of  these  symp- 
toms, the  persistence  of  an  unbalanced  force,  that  can  con- 
vert functional  into  oriranic  disease. 


THE    CAUSES    OP    ILL-HEALTH.  41 

Thus,  to  seek  a  practical  example,  it  cannot  be  said  that 
the  symptom  called  diarrhoea  can,  if  neglected,  produce 
dysentery,  but  it  is  the  persistence  of  the  cause  that  pro- 
duced the  diarrhoea,  the  impossibility  of  getting  at  it  and 
removing  it,  which  is  the  cause  of  the  dysentery.  As  far 
as  the  mere  symptom,  diarrhoea,  is  concerned,  its  aim  is 
purely  beneficial. 

To  this  argument,  which,  if  correct,  would  prove  ortho- 
dox medicine  —  at  the  best  so  notoriously  unsuccessful, 
when  subjected  to  practical  tests,  as  to  raise  serious  ques- 
tion as  to  the  morality  of  its  use  among  the  higher  ranks 
of  those  who  now  profess  it— to  be  founded  upon  gross 
physical  error,  upon  a  misinterpretation  of  natural  phe- 
nomena, the  only  serious  reply  that  can  be  made  is  as  fol- 
lows :  May  we  not,  say  the  advocates  of  the  orthodox 
system,  support,  by  means  of  suitably  adapted  physic,  the 
body  locally  or  generally,  and  thus  enable  it  to  withstand 
the  effect  of  these  adverse  forces  which  threaten  its  de- 
rangement or  its  overthrow;  just  as,  in  the  case  of  the 
Kentish  rock,  w^e  might  arrest,  by  exerting  pressure  on 
the  side  opposite  to  that  on  which  another  one  was  press- 
ing, the  swaying  movements.  Certainly,  but  conditions, 
all  wanting,  are  necessary  to  give  success  where  the  human 
body  is  concerned.  In  the  first  place,  you  must  possess, 
in  medicines  proper,  agents  equal  to  the  task,  you  must 
be  able  to  control  and  localize  their  action,  and  you  must 
obviously  apply  your  counter-force  at  the  right  moment, 
the  very  start.  Moreover,  you  must  be  able  to  gauge  ex- 
actly the  adverse  forces.  Now,  the  only  agents  that  can 
generate  force  in  conjunction  with  the  bodily  cells  are 
foods,  and  these  must  be  given  prior  to  the  attack  of  dis- 
ease. No  known  drug  —  if  we  except  such  drugs,  e.g., 
cod-liver  oil,  as  are  really  foods — has  any  power  to  gener- 
ate in  the  body  any  force,  though  some,  of  which  nature 


42  THE    PRINCIPLES    OF    ILL-HEALTH. 

are  the  stimulants  and  tonics,  can  liberate  force  already 
stored  in  the  cells,  leaving  the  latter  afterwards  weakened 
raid  palsied.  In  great  emergencies,  extending  only  over 
a  few  hours,  and  as  a  mere  jo/*"  aller,  such  stimulating 
treatment  may  in  rare  instances  be  recommended.  Even 
then  it  is  fraught  with  subsequent  danger,  while  to  attempt 
to  apply  it  generally  in  disease  would  indeed  be  a  midsum- 
mer madness.  Again,  of  no  medicine  can  the  effect  be 
really  localized  or  controlled.  The  medicine,  w^hich  you 
wish  to  do  merely  one  or  two  things,  persists,  when  it  en- 
ters the  body,  in  effecting  a  dozen  other  changes  that  you 
do  not  desire.  Yet  more,  you  know  nothing  of  the  kind 
and  intensity  of  the  forces  you  wish  to  counteract,  and  but 
little  of  the  direction  in  which  they  act.  Who,  for  ex- 
am^^le,  can  pretend  to  give  a  real  sketch  of  the  order  and 
variety  of  phenomena  to  which  a  single  fever  germ  gives 
rise  ? 

As  a  matter  of  fact,  however,  orthodox  medicine  never 
recommends  really  the  combating  of  a  cause,  the  opposi- 
tion to  it  of  an  equal  force,  a  principle  that  would  be  in- 
telligent, even  though  its  carrying  out  were  plainly  impos- 
sible; a  brief  study  of  the  standard  works  on  therapeutics 
will  show  that  it  tries  to  effect  something  very  different, 
something  easier,  something  indisputably  wrong.  It  seeks 
the  arrest  of  sj^mptoms  after  they  have  arisen.  It  com- 
bats these  while  deluding  itself  into  the  belief  that  it  is 
sapping  their  causation.  Now  just  imagine,  in  the  case  of 
the  pendulum,  what  risks  would  attend  the  sudden  arrest 
of  the  exaggerated  movements  which  ensue  on  a  disturb- 
ance of  its  equilibrium;  the  extra  force  must  either  be 
quickly  distributed  over  the  body  that  shall  arrest  these, 
or  the  pendulum  itself  will  run  the  greatest  risk  of  frac- 
ture. But  no  drug  can,  fortunately,  act  as  a  buffer  to  the 
symptoms  of  disease.     What  drugs  do,  what  the  thera- 


THE    CAUSES    OF    ILL-HEALTH.  43 

peutist  does,  is  to  direct  the  symptoms,  to  prevent  the 
effects  of  the  mischief  passing  off  most  easily  by  the  chan- 
nel of  the  least  resistance,  that  selected  of  necessity  by 
Nature,  and  foolishly  to  distribute  it  over  a  dozen  other 
ones.  A  diarrhoeic  symptom  is  arrested,  but  the  skin, 
lungs,  and  kidneys  pay  a  heavy  price,  unknown  to  the  pa- 
tient, for  the  questionable  service.  They  must  pay  it,  if 
the  law  that  energy  is  indestructible  be  not  an  erroneous 
one. 

It  would  not  be  difficult,  though  it  would  occupy  too 
much  space,  to  show  that,  as  regards  the  race  of  man,  dis- 
ease itself  is  a  benefit,  cutting  off  the  weaklings,  improv- 
ing and  rendering  more  secure  the  lives  of  the  stronger; 
Avhile  as  regards  the  individual  man  the  symptoms  of  dis- 
ease are  his  real  friends,  the  only  bulwarks  between  him- 
self and  worse  evils. 

The  words  of  Pope  may  not  inaptly  close,  for  the  pres- 
ent, this  subject: 

"  All  nature  is  but  art,  unknown  to  thee; 
All  chance,  direction,  which  thou  canst  not  see; 
All  discord  harmony  not  understood  ; 
All  partial  evil,  universal  good ; 
And  spite  of  pride,  in  erring  reason's  spite. 
One  truth  is  clear,  whatever  is,  is  right." 

Having  dealt  with  the  rationale  of  the  symptoms  and 
consequences  of  loss  of  equilibrinm,  of  ill-health,  let  me 
seek  in  each  of  its  dej)artments,  the  functional  and  the  or- 
ganic, a  homely  illustration  of  the  principles  involved. 

Functional  Disorder. — D.,  who  has  of  late  been  much 
depressed  in  health  by  overwork  and  worry,  goes  to  a  ball, 
feeling  somewhat  fagged,  but  otherwise  fairly  well.  He 
experiences  fatigue  in  the  course  of  an  hour  or  two,  which 
is  relieved  for  a  time  by  a  few  glasses  of  wine.  He  goes 
home  at  an  earlier  hour  than  is  usual,  and,  though  the 


44  THE    PRINCIPLES    OF    ILL-HEALTH. 

night  be  fairly  mild,  experiences  on  his  way  very  distinct 
sensations  of  cold.  After  retiring  to  rest  he  finds  it  diffi- 
cult to  get  warm,  and  wakes  up  next  morning  with  the 
ordinary  symptoms  of  catarrh  in  the  head,  which,  in  twen- 
ty-four hours,  extend  to  his  chest  and  are  accompanied  for 
some  days  by  slight  feverishness,  lessening  of  the  appetite 
and  of  the  excretions,  an  increase  of  thirst,  and,  in  short, 
all  the  ordinary  signs  of  a  cold. 

The  interpretation  of  the  sequence  here  is  easy.  The 
worry  which  preceded  his  going  to  the  ball  weakened  the 
action  of  the  nervous  system,  and  lessened  the  resisting 
powers  of  the  body,  so  that  even  moderate  cold,  following 
upon  the  heat  of  the  ball-room,  by  acting  upon  him  as  a 
force  which  his  body  could  not  balance,  sufficed  to  pro- 
duce the  malady.  On  his  way  home  the  contraction  of 
the  blood-vessels  in  the  skin,  brought  into  contact  with  a 
colder  atmosphere,  was  a  benefit;  had  it  not  occurred  he 
would  have  lost  heat  rapidly  by  radiation,  and  might 
thereby  have  run  a  grave  risk  of  death..  The  nerves  of 
the  body,  how*ever,  failed  to  perform  their  ordinary  duty, 
to  distribute  the  extra  blood  thrown  suddenly  upon  the 
internal  organs  evenly  among  the  latter,  and  as  a  result 
the  superficial  layers  of  tissue  in  the  throat,  nose,  and 
bronchial  tubes,  probably  because  they  were  most  exposed 
to  the  action  of  the  cold,  were  the  chief  seats  of  the  symp- 
toms, and  became  congested,  receiving  more  than  their 
normal  supply  of  blood.  No  one  will  surely  deny  that,  in 
such  a  state  of  matters,  this  congestion,  this  symptom  of 
derangement,  was  beneficial.  Had  it  not  occurred,  had  the 
blood-vessels  not  been  susceptible  of  this  dilatation  they 
would  have  given  way,  would  have  burst,  or  a  congestion 
of  some  other  part,  but  still  a  congestion,  and  for  the  same 
reason  beneficent,  would  have  occurred.  The  bronchial 
and  nasal  congestions  are  followed  by  a  secondary  symp- 


THE    SYMPTOMS    OF    DISEASE    BENEFICIAL.  45 

torn,  for  from  the  dilated  blood-vessels  begins  to  ooze 
fluid,  and  the  more  this  fluid  escapes,  and  the  more  the 
p&tient  gets  rid  of  it  by  coughing  and  clearing  his  throat 
and  nose,  the  easier  he  becomes.  The  rapidity  of  breath- 
ing, another  symptom,  was  equally  beneficial,  for,  the  nor- 
mal aerating  power  of  the  lungs  being  crippled  by  this 
congestion,  a  greater  number  of  respirations  was  requi- 
site to  perform  the  necessary  amount  of  work.  The  les- 
sened appetite  was  another  good,  for,  in  the  state  of  f ever- 
ishness,  consequent  on  the  chill,  but  little  assimilation  by 
the  cells  was  possible,  and  food  taken  in  the  ordinary 
amounts  would  have  taxed  severely  and  injuriously  the 
already  lessened  power  of  the  kidneys  and  skin.  Thirst 
was  a  benefit  as  tending  to  promote  assimilation,  to  thin 
the  blood,  and  to  restore  the  functions  of  the  kidneys. 
Even  the  feverishness,  the  rise  of  temperature,  had  its 
good  uses,  for,  by  lessening  the  intake  of  much  food 
and  consequent  increase  of  the  already  excessive  blood 
pressure  in  the  internal  organs,  it  promoted  a  return  to 
health. 

So  that  really  all  the  phenomena  witnessed  had,  as  sole 
end,  a  return  as  speedily  as  possible  of  the  body  to  a  nor- 
mal state,  a  return  which  is  complete  in  a  few  days  if  the 
sufferer  merely  keeps  in  an  equable  and  mild  atmosphere 
— i.  e.,  if  he  keeps  the  cause  of  his  derangement  at  bay. 
If  any  form  of  artificial  treatment  be  attempted  it  should, 
in  this  case,  surely  take  the  form  of  an  imitation  and  as- 
sistance of  those  efforts  which  Nature  is  herself  so  wisely 
making  to  insure  a  return  of  the  bodily  equilibrium.  Even 
then  it  would  probably  do  more  harm  than  good,  since 
such  treatment  would  be  in  the  nature  of  a  local  stimula- 
tion, and,  as  such,  would  be  followed  speedily  by  reaction, 
Avhich  latter  process  might  lead  to  further  dangerous  mis- 
chief.    If  people  could  only  often  \\:itness  a  comparison 


46  THE    PEINCIPLES    OF    ILL-HEALTH. 

between  the  rate  and  perfection  of  recovery  in  cases  where 
the  derangement  is  allowed  to  run  its  course,  and  those  in 
which  it  is  actively  interfered  with,  they  w^ould  be  disillu- 
sioned of  their  reliance  on  drugs.  They  do  not  know  how 
often  the  complications  arising  in  a  complaint  are  accred- 
ited to  the  malady  and  the  recovery  to  the  drug,  whereas 
the  recovery  is  due  to  the  natural  course  of  the  malady, 
and,  in  at  least  half  the  cases,  the  complications  are  due 
to  the  drugs.  This  may  seem  too  sw^eeping  a  statement, 
and  yet  if  people  will  but  remember  that  the  methods  of 
treating  similar  derangements  by  different  medical  men 
are  usually  widely  different,  and  that  out  of  all  the  adopt- 
ed plans  but  one  can  really  be  correct,  they  must  agree 
Avith  me  that  the  j^ractice  of  medicine,  unless  built  on  very 
sure  ground,  on  facts  that  can  be  demonstrated  to  be 
truths — whole  truths,  not  the  half-truths  of  the  ordinary 
therapeutist — and  pursued  wdth  the  utmost  caution,  may 
well  deserve  the  censure  which  Shakespeare  puts  into  the 
mouth  of  Timon: 

"  Trust  not  to  the  ph3'sician; 
His  antidotes  are  poison,  and  he  slays 
More  than  you  rob." 

If,  instead  of  seeking  an  example  of  this  variety  of  loss 
of  balance,  in  the  case  of  a  man  whose  bodily  power  is  be- 
low par,  we  had  chosen  to  instance  a  man  of  normal  vigor 
exposed  to  the  action  of  some,  to  him,  unusual  force,  such 
as  excessive  cold  and  damp,  we  should  have  witnessed 
the  same  result  as  that  already  described,  and  the  phe- 
nomena observed  would  have  admitted  of  the  same  inter- 
pretation. 

Organic  Disease. — We  now  turn  to  a  class  of  derange- 
ment which  is  of  much  greater  importance,  to  that  which 
results  in  destruction  of  some  portion  of  the  body,  and 
which  renders  the  subsequent  course  of  life  an  exceeding- 


ORGANIC    DISEASE.  47 

ly  uncertain  one,  and  Avbicli,  unless  the  invalid  can  protect 
himself  by  an  artificial  environment  suited  to  his  damaged 
structure,  must  result  in  curtailment  of  life,  while  it  always 
exposes  the  patient  to  grave  risk  of  death  from  what,  in 
secure  health,  would  be  called  trivial  causes. 

The  following  will  serve  as  an  illustration  of  this  vari- 
ety of  disorder: 

E.,  a  London  business  man  of  middle  age,  unused  for 
years  to  great  muscular  exertions,  in  place  of  his  usual 
Margate  holiday  trip,  taken  oi  faniille,  accompanies  some 
young  friends  in  a  rowing  excursion  on  the  Thames.  A 
few  days  of  such  exertion,  combined  with  the  exposure  to 
damp  at  night  in  the  camping-out,  which  is  a  part  of  the 
programme,  suffices  to  bring  upon  him  all  the  symptoms 
of  rheumatic  fever,  and  to  confine  him  for  three  or  four 
months  to  a  warm  bedroom.  At  the  end  of  that  time  he 
feels  himself  again,  though  his  doctor  has  warned  him  that 
a  valve  in  his  heart  has  become  incompetent  by  conse- 
quence of  the  violence  of  the  attack  of  illness  through 
which  he  has  just  passed. 

His  body  is  now  in  a  state  of  insecure,  of  really  imper- 
fect equilibrium,  one  that  under  the  ordinary,  the  former, 
conditions  of  life  must  lead  to  premature  death.  How 
comes  it,  then,  that  the  patient  feels  as  w^ell  as  ever  ? 
Every  day  the  forces  in  the  environment  are  outbalancing 
the  sum  of  the  forces  in  the  body;  but  where  are  the  per- 
turbations due  to  this  ?  In  the  heart  itself,  which,  by  un- 
dergoing organic  change  in  the  shape  of  thickening  of 
that  cavity  which  is  closed  by  the  defective  valve,  is  still 
effecting  a  balance.  But  this  process  must  come  to  an  end 
before  long,  for  this  forced  expenditure  of  the  energy  in 
the  heart  cells  must,  under  any  circumstances,  lead  to  their 
premature  exhaustion,  and  thus  to  an  arrest  of  their  multi- 
plication and  of  their  functions.     The  day  of  failure  then 


48  THE    PKIXCIPLES    OF    ILL-HEALTH. 

comes  ;  henceforward  the  heart  falls  out  of  line  with  the 
other  bodily  organs.  Suppose  the  old  course  of  life  to  be 
still  pursued,  the  symptoms  attendant  on  the  discrepancy 
between  the  bodily  force  and  the  forces  resident  in  the 
conditions  of  this  man's  life  now  begin  to  be  developed  in 
other  organs;  the  breathing  becomes  short  and  so  on;  but 
even  these  symptoms  have,  in  the  bodily  condition  now 
under  review,  an  aim  conservative  of  life.  Later  on,  yet 
another  beneficent  symptom,  dropsy,  supervenes.  But  for 
this  exudation  of  fluid  from  the  distended  blood-vessels, 
these  latter  must  give  way,  or  the  current  within  them 
must  be  arrested,  either  of  which  events  would  cause 
death.  Finally,  even  the  limits  within  which  dropsy  can 
save  our  embarrassed  patient  are  reached,  and  death  re- 
sults. 

Gloomy  as  is  such  a  record,  it  must  strike  the  reader 
forcibly  that  the  exercise  of  a  little  common-sense  on  the 
part  of  the  patient  might  have  done  much  for  him.  Had 
he,  in  the  earlier  stages,  only  cut  down  his  environment, 
his  habits  of  life,  to  the  impaired  structure  of  his  body — 
life  by  such  a  course  might  have  been  saved,  and  even 
when  his  breathing  became  impaired,  wise  economy  in  re- 
spect of  the  demands  made  on  his  bodily  powers  must  have 
secured  a  longer  lease  of  life. 

Finally,  in  organic  disease,  the  proportion  between  the 
forces  in  a  body  and  those  in  its  environment  may  be  so 
dissimilar  that  death  of  the  whole  body  may  quickly  re- 
sult. Thus  a  human  body  immersed  in  water  is  brought 
suddenly  into  contact  with  conditions  normal  to  a  fish  or 
even  to  the  mammalian  whale,  but  incompatible  with  hu- 
man life. 

Under  organic  disease  must  also  be  classed  every  inher- 
ited structural  change  in  the  man.  A  few  words  of  ex- 
planation will  make  this  clear.     We  have  in  congenital 


CONGENITAL    BODILY    DEFECTS.  49 

diseases,  such  as  scrofula,  goQt,  inlierited  syphilis,  inher- 
ited insanity,  idiocy,  etc.,  examples  of  a  sufferer  starting 
in  life  with  a  structural  flaw — ^never,  from  the  very  first, 
can  he  equilibrate  properly  the  environment  of  healthier 
beings  born  under  the  same  climatic  conditions.  We  have 
in  these  cases  a  faulty,  an  imperfect,  equilibrium  from 
conception,  the  body  being  comparable  to  a  badly  made 
watch,  which  can  never  be  made  to  indicate,  for  more  than 
a  very  short  period,  the  right  time. 

We  all  know  that  such  unfortunate  individuals  can 
never  be  placed  on  a  par  with  their  healthier  neighbors  of 
a  similar  age.  We  may,  by  "tempering  the  wind  to  the 
shorn  lamb  " — in  other  words,  by  artificially  suiting  the 
environment  to  the  special  conditions  present — keep  down, 
or  avert  for  a  time,  further  structural  mischief;  but  the 
risk  of  such  mischief  is,  as  every  practical  man  knows,  at 
all  times  very  great.  These  weaklings  are  the  children  of 
elderly,  degenerating  parents,  or  of  parents  with  some, 
possibly  latent  and  unsuspected,  structural  weakness.  They 
are  commonly  the  offspring  of  marriages  of  consanguinity, 
the  children  possessing  a  double  dose,  one  from  each  pa- 
rent, of  any  family  failing,  and  therefore  exhibiting  very 
markedly  some  one  defect. 

The  so-called  tumors,  new  growths,  such  as  cancers, 
fibroids,  etc.,  never  spring  from  degenerated  tissues,  for 
the  vitality  of  the  cells  of  such  are  exhausted,  but  from 
tissue  possessing  some  balance  of  vital  energy,  which  bal- 
ance is  exhausted,  or  largely  so,  in  the  growth ;  it  is  prob- 
able that  cancers  spring  from  embryonic  cells,  from  cells 
that  have,  from  various  reasons,  lain  dormant — slept,  as 
did  the  hare  in  the  fable — during  the  race  of  life,  and 
which  some  irritation  has  suddenly  aronsed  to  life  and 
excessive  growth. 

The  cancers,  and  other  so-called  malignant  tumors,  are 
3 


60  THE    PEINCIPLES    OF    ILL-HEALTH. 

dangerous  mainly  by  reason  of  the  special  adaptability 
of  their  cells  to  travel  by  the  blood  and  lymph  channels, 
and  then  to  set  up  similar  growths  in  other  and  distant 
parts  of  the  body. 


CHAPTER  lY. 

THE  PRINCIPLES  OF  SCIENTIFIC  jMEDICINE. 

TREATMENT  BY  ORDrNAEY  MEASURES. 

Resume  of  position.  The  ordinary  measures  of  treatment,  food, 
climate,  and  liabit.  —  I.  Foods.  Rules  to  guide  us  in  their 
administration.  These  rules  as  modified  by  disease.  Food 
accessories  and  artificial  digestive  agents. — II.  Climate.  The 
purity,  temperature,  and  humidity  of  the  air  and  the  effects  of 
these  on  health. — III.  Habits  and  modes  of  life.  Fallacies  of 
hygienists.     General  rules. 


CHAPTER    IV. 

THE  PRINCIPLES  OF  SCIENTIFIC  MEDICINE. 

TKEATMENT  BY  ORDLNARY  MEASURES. 

"  La  nature  est  formatiice,  couservatrice,  et  medicatrice.  Voila  le  priii' 
cipe  fondamental  de  la  medecine. 

"II  n'y  a  qu'une  medecine,  celle  qui  repose  sur  les  lois  de  la  nature. 
.  .  .  Nous  avons  eu  jusqu'ici  assez  de  systemes  pour  savoir  que  la  mede- 
cine ne  reside  point  en  eux." — Ed.  Auber. 

"  Peu  de  maladies  guerissent  dans  les  circonstances  et  les  lieux  ou  elles 
naissent  et  qui  les  ont  faites.  Elles  tiennent  a  certaines  habitudes  que 
ces  lieux  perpetuent  et  rendcnt  invincibles.  Nulle  reforme  pour  qui 
reste  dans  son  peche  origiuel.  ... 

"  La  terre  est  son  medecin ;  chaque  climat  est  un  remede.  La  mede- 
cine, de  plus  en  plus,  sera  une  emigration,  une  emigration  prevoyante." 

— MiCHELET. 

Hitherto  we  have  discussed,  perforce  with  the  utmost 
brevity,  and  only  in  general  terms,  the  great  foundations 
on  which  medicine,  if  it  aspire  to  the  rank  of  a  science, 
must  rest. 

So  essential  is  it  that  these  great  underlying  principles 
should  be  engraved  on  the  mind  of  the  physician — be  he 
amateur  or  professional — that,  at  the  risk  of  being,  con- 
victed of  tedium,  I  shall  venture,  ere  an  advance  is  sound- 
ed to  the  practical  points  of  treatment,  on  a  brief  recapitu- 
lation of  the  present  standpoint. 

I.  Human  life  consists  of  two  movements'. 

(a)  Molecular  Movement  (i.  e.,  chemical  activity  or 
chemical  movement)  occurring  between  each  cell  and  its 
cell-food,  albumen.     The  net  results  of  this  ceaseless  proc- 


54  THE    PRINCIPLES    OF    SCIENTIFIC    MEDICINE. 

ess  are,  as  explained  in  our  first  chapter,  multiplication 
of  cells  or  growth,  specialization  of  cells  or  development,* 
and  the  evolution  of  some  few  of  the  energies  of  life. 

The  original,  or  germ,  cell,  the  progenitor  of  all  the 
body  cells,  is  a  somewhat  intricate  compound,  consisting, 
nevertheless,  of  but  six  ordinary  elements.  Its  latent  or 
dormant  power  is  due  solely  to  its  intricacy  of  structure, 
to  the  fact  that  it  contains  stored  up  w^ithin  itself  the 
energy  expended  by  its  parents  in  the  j^roduction  of  its 
complex  structure.  This  latent  molecular,  or  chemical, 
energy  exhausts  itself  gradually  on  the  albumen  with 
which  it  is  brought  into  contact,  and  thus  new  com- 
pounds, new  cells,  at  an  ever  gradually  decreasing  rate, 
are  produced. 

Eventualh^  and  as  a  natural  consequence  of  the  process 
just  described,  both  intricacy  of  cell  structure  and  emis- 
sion of  energy  become,  the  first  so  simplified,  the  second 
80  minimized,  that  no  further  chemical  interchange  be- 
tween cell  and  albumen  can  occur;  then  ensues  natural 
death. 

The  germ-cell  thus  contains  no  special,  no  supernatural, 
energy;  its  action  on  albumen  is  closely  similar  to  that  of 
a  coiled  watch-sj^ring,  or  an  elevated  weight,  on  a  clock 
mechanism.  The  price  of  each  vital  act  in  man,  as  of 
each  revolution  of  the  smallest  wheel  in  the  clockwork, 
is  dissipation  of  a  portion  of  that  limited  energy  to  which 
alone  the  movements  of  both  man  and  clock  are  due. 

(b)  Mechanical  Motiement. — This  variety  of  movement 
— not  essentially  different  from  the  molecular,  or  chemi- 
cal, form,  if  chemistry  be  regarded  as  a  branch  of  physics 
— is  that  which  we  witness  when  the  whole  body,  or  a 
distinct  portion  thereof,  is  set  in  motion  by  means  of  the 

*  Food  but  partially  specializes  cell  tissue ;  other  environing  forces 
take  a  lar^c  share  therein. 


RESUME   OF   OUR   CONCLUSIONS.  55 

store  of  beat-energy  produced  by  tbe  combustion  of  fuel- 
food  (fats  and  starches)  within  its  tissues.  The  origin  of 
this  heat-energy  and  the  method  by  which  it  produces 
motion  are  identical  in  man  and  in  the  ordinary  steam 
locomotive,  though  in  the  human  machine,  by  far  the 
more  perfect  of  the  two,  combustion  is  not  only  more 
complete,  but  the  regulation  and  the  steering  of  the  ma- 
chinery are  also  provided  for. 

The  molecular  movement  therefore  builds  man  and  en- 
dows him  with  life  in  its  most  restricted  sense;  mechani- 
cal movement  works  the  formed  and  complete  machinery. 

The  demand  for  albumen  steadily  decreases,  ^er  unit 
iveight  of  living  bodily  tissue,  from  conception  to  death; 
that  for  fuel-foods  shows  also,  under  conditions  of  perfect 
tranquillity,  a  similar  decline — for  the  heat-storage  power 
of  cells  decreases  as  they  simplify — but  this  latter  fall  is 
masked  by  the  fact  that  with  all  increase  of  work,  up  to  a 
certain  limit,  a  proportionate  increase  of  fuel-food  is,  of 
necessity,  demanded. 

II.  We  now  view  man  as  a  single,  complete  being. 

As  such  he  represents  a  comparatively  small  and  fairly 
constant  sum,  or  aggregate,  of  forces,  brought  ever  into 
contact  with  the  inexhaustible  and  varjdng  forces  (the 
aggregate  of  forces)  in  his  environment. 

If  man  is  to  exist,  his  body  must  be  able,  without  de- 
struction of  any  essential  part,  to  effect  a  ready  balance 
with  these  environing  forces.  Since,  however,  the  sum  of 
forces  in  both  body  and  environment  is  ever  changing, 
actual  stable  equilibrium  is  not  attainable,  but  the  body 
oscillates  rhythmically,  like  a  pendulum,  about  its  centre 
of  stable  equilibrium. 

These  rhythmical  oscillations  are  represented  by  the  reg- 
ular movements  of  health,  breathing,  heart-beating,  etc. 

III.  If  this  general  moving  condition  of  equilibrium  be 


66  THE    PEINCIPLES    OF    SCIENTIFIC    MEDICINE. 

disturbed,  cither  by  some  unusual  deficiency  in  the  body 
or  excess  of  force  in  its  environment,  the  effects  ob- 
served will  depend  exactly  upon  the  amount  of  force 
present  in  the  environment  in  excess  of  that  needed  for  the 
rhythmic  health  movements,  and  this  excess  force  will, 
(a)  if  it  be  slight  and  its  action  but  temporary,  produce 
exaggerated  oscillations  (increase,  or  other  derangement, 
of  normal  breathing,  etc.)  until,  being  balanced  by  the 
latter,  the  regular  oscillations  of  health  will  return.  This 
series  of  phenomena  constitutes  functional  disorder,  (b) 
But  if  severe  and  temporary,  it  will  produce  the  same 
phenomena,  plus  destruction  of  tissue.  This  is  known  as 
organic  or  structured  disease.  If  the  part  destroyed  be 
not  a  vital  one,  a  secondary  and  imperfect  state  of  mov- 
ing equilibrium  will,  in  the  course  of  time,  be  established. 

If  the  excessive  force  be  permanent,  it  will  produce,  in 
a,  a  chronic  state  of  functional  disorder,  ending  in  pre- 
mature exhaustion  of  the  mechanism  (whether  clock  or 
body),  and,  in  J,  will  tend  to  a  still  more  rapidly  fatal 
termination. 

Such,  then,  are  our  positions  compressed  into  the  small- 
est possible  space.  We  have  but  two  great  classes  of  dis- 
ease to  deal  with:  \\y!Q  functional  variety,  with  its  accom- 
panying symptoms,  all  beneficial,  because  all  tending  to 
counterbalance  that  excess  of  force  present  which  is  be- 
yond the  normal  of  health,  and  all  ceasing  when  that  force 
has  been  finally  balanced.  The  body  of  man  in  such  an 
emergency,  like  the  sapling  in  a  gale,  bends  before  the 
storm  to  rise  again  erect  and  unhurt  when  the  winds  have 
fallen.  In  the  second  variety,  the  structural,  the  body  of 
man  again,  in  proportion  to  its  youth  and  the  elasticity  of 
its  frame,  bends  at  first,  but,  when  the  utmost  limit  of 
elasticity  in  some  parts  has  been  reached,  there  will  yet 
remain,  pressing  on  those  parts  of  his  body,  a  force  still 


KESUME    OF    OUR    CONCLUSIONS.  57 

unbalanced — then  are  such  parts,  which  are  those  that  are 
weakest  and  which  offer  most  surface  to  the  force  of  the 
storm,  broken  or  blown  aAvay,  and  when  the  gale  has 
passed  and  the  nninjured  parts  again  erect  themselves,  the 
body  shows  its  damage  and  bears  lasting  marks  of  the 
danger  through  which  it  has  passed.  Finally,  parts  of 
the  structure  essential  to  life  may  be  destroyed,  in  which 
case  no  recuperation  is  possible.  This  corresponds  to 
death.  Structural  disease  is,  as  regards  the  individual,  an 
evil,^  in  so  far  as  it  entails  destruction,  to  a  greater  or  less 
extent,  of  his  bodily  mechanism;  but  as  it  affects  mankind 
in  general,  it  is  a  benefit,  since  by  its  aid  the  human  fam- 
ily is  gradually,  and  to  its  lasting  good,  purged  of  its 
weaker  and  less  perfect  members. 

There  is  perhaps  yet  one  more  point  to  which  a  few 
lines  of  explanation  are  due.  What  part,  it  may  be  asked, 
does  the  spirit  of  man — his  soul — play  in  the  processes  of 
physical  life  ?  Apparently  none  whatever.  The  body  of 
man  generates  no  energy,  that  which  it  emits  is  the  exact 
equivalent  of  that  which  it  acquires  from  its  foods,  and 
life  is  the  result,  not  the  cause,  of  energy.  The  spirit  of 
man  has  no  share  in  the  working  of  his  physical  structure. 
It  cannot,  in  fact,  participate  in  a  material  process,  unless 
our  definition  of  it  and  our  knowledge  of  matter  and  en- 
ergy be  both  at  fault,  for  if  the  spirit  be  immaterial,  it 
cannot  contain  that  which  alone  can  influence  the  body — 
energy — since  energy  can  exist  but  in  union  with  matter, 
in  fact  is  probably  identical  with  matter.  Much  mystifi- 
cation in  the  public  mind  has  arisen  from  the  vague  and 
emotional  tones  in  which  some  even  good  scientific  men 
speak  of  the  human  germ-cell.  They  will  ofttimes  invest 
it,  as  does  the  love-sick  swain  his  Dulcinea,  with  hypothet- 
ical charms  and  virtues,  Does  the  germ-cell  contain  a 
diamond  edition  of  man  ?  are  the  various  portions  of  the 

3'H 


58  THE    PRINCIPLES    OF    SCIENTIFIC    MEDICINE. 

body  already  contained  in  it  but  invisible  to  us  by  reason 
of  their  minuteness?  Does  this  cell  contain  a  special, 
vital  force  ?  What  are  these  mysterious  somethings,  life 
and  power  of  growth,  which  it  possesses  ?  Such  are  a  few 
of  the  fanciful  problems  with  which  these  philosophers 
torture  and  perplex  their  own  minds  and  those  of  their 
disciples.  As  logically  might  they  ask  if  the  water  of  a 
stream  that  kept  in  motion  a  paper  manufactory,  itself 
contained  the  paper,  or  if  the  coiled  watch-spring  or  the 
elevated  clock-weight  contained  the  wheels  and  jjins,  dial- 
plates  and  hands  of  the  clock.  The  germ-cell  corresponds 
to  the  falling  water,  containing  like  it  a  simple  potential 
energy,  the  albumen  (^.  e.,  tissue-food)  ever  presented  to  it 
corresponds  to  the  machinery  of  the  mill  and  the  raw  fibre 
in  its  tanks.  The  result  in  the  one  case  is  a  man,  in  the 
other  paper.  If  the  emotional  scientist  must  give  vent  to 
his  emotions  over  some  material  idol,  let  him  then  adore 
rather  the  albuminous  food,  by  far  a  more  important  factor 
in  the  production  of  a  human  being  than  is  the  germ-cell.* 
And  now  to  the  question  of  treatment.  As  all  disease 
may  be  conveniently  divided  into  functional  and  organic, 
so,  for  the  sake  of  clearness  and  convenience,  may  all 
measures  for  its  relief  be  spoken  of  as  ordinary  or  extraor- 
dinary. The  classification  is,  I  am  well  aware,  bad  and 
utterly  unscientific,  since  derangement  can  be  proj^erly 
met  only  by  such  agent  or  agents  as  exactly  counterbal- 
ance the  effects  of  the  cause  of  such  disorder,  and  as  no 
disease  is  in  a   proper   sense   extraordinary,  neither  can 

*  I  do  not  of  course  deny  the  existence  of  a  supernatural  spirit  in 
man,  tbougli  neither  belief  nor  denial  is  here  in  question,  but  I  pro- 
test most  strongly  against  the  assumption  of  an  unknotrn  agency  in 
man  and  the  subsequent  adoption  of  such  agency  as  a  known  and 
potent  factor  in  physical  phenomena.  It  is  to  sucli  trickery  only 
that  I  object. 


ORDINARY  MEASURES  OF  TREATMENT.        59 

there  be  a  remedy  to  which  such  an  expression  can  apply; 
yet  so  tangled  is  the  maze  of  applied  medicine  as  usually 
understood,  so  overgrown  with  the  weeds  of  untenable 
theory  and  of  incomplete  experiment — the  former,  as  we 
shall  see,  a  form  of  fallacy  known  as  the  suggestio  falsi,  the 
latter  of  the  nature  of  a  siq'>2^ressio  veri — that  I  have 
found  it  impossible  to  deal  with  the  whole  subject  of 
treatment  as  one,  and  have  been  compelled  to  divide  it 
into  two  categories,  the  former,  the  so-called  ordinary 
measures,  to  comprise  the  well-known  forces  of  Nature  in 
their  usual  garb;  the  latter,  the  extraordinary,  certain  con- 
centrated and  less  known,  or  more  complex,  natural  forces 
popularly  recognized  as  drugs. 

Ordinary  Pleasures  of  Treatmeyit. 

The  ordinary  means  at  the  disposal  of  man  for  the  main- 
tenance of  his  health,  or  for  its  restoration  when  lost,  are 
capable  of  being  grouped  into  the  three  headings  of  food, 
climate,  and  habit.  They  represent  the  three  powers  most 
ready  to  his  hand,  and  to  which  he  naturally  first  turns  to 
effect  the  process  of  re-equilibration. 

Bearing  in  mind  that  we  are  concerned  as  yet  only  with 
the  principles,  the  rationalia,  of  treatment,  and  that  its 
practical  details  fall  to  be  discussed  in  the  second  part  of 
this  book,  I  shall  limit  myself  to  the  enunciation  of  gen- 
eral facts  only. 

I.  Food. 

The  necessary  aliment  of  man  consists  of  four  very  dif- 
ferent varieties  of  substance. 

{a)  Tissue-food,  or  albumen,  derived  from  the  once  liv- 
ing and  therefore  most  highly  organized  parts  of  plants 
and  animals.  The  flesh  of  animals  and  the  seeds  of  plants 
(storehouses  of  potential  life)  are  representative  structures, 
rich  in  this  tissue-food. 


60  THE    PRINCIPLES    OF   SCIENTIFIC    MEDICINE. 

The  duty  of  tissue-food  is — after  it  has  undergone  con- 
version from  the  colloid  to  the  crystalloid  state  by  means 
of  digestion,  has  then  entered  the  blood-stream  and  under- 
gone some  combustion  in  the  liver — to  interact  chemically 
with  the  living  cells  of  man's  body,  and  to  thus  produce 
the  essential  phenomena  of  continued  life.  Tissue-food, 
in  short,  in  conjunction  with  living  cells,  causes  the  body 
to  grow  at  first,  and  afterwards  maintains,  but  with,  of 
necessity,  a  gradually  decreasing  power  as  the  cell  energy 
becomes  lowered,  the  living  structure. 

(b)  Fuel-food,  represented  by  the  fats,  sugars,  and 
starches,  is — after  its  conversion  by  digestion  from  a  col- 
loid to  a  crystalloid  form — absorbed  into  the  blood,  and,  by 
means  of  the  oxygen  contained  in  that  fluid,  burned  (oxi- 
dized) so  as  to  supply  heat-energy,  necessary  for  the  bodily 
movements. 

It  must  be  admitted  that  even  albumen  undergoes  some 
combustion  and  therefore  assists,  though  but  to  a  trifling 
extent,  in  the  development  of  the  heat-energy. 

(c)  Water.  Necessary  to  dissolve  the  crystalloids  and  to 
keep  them  in  solution  in  the  blood. 

{d)  Inorganic  salts,  of  which  common  salt  is  the  chief. 
These  seem  to  assist  the  chemical  actions  without  taking 
part  in  them.  They  have  been  compared,  somewhat  in- 
accurately, to  the  oil  used  to  lubricate  machinery. 

Now,  let  us  see  if  we  can  arrive  at  anything  like  a  use- 
ful general  rule  to  guide  us  as  to  the  necessary  amount  of 
each  of  these  foods  in  a  condition  of  health,  for  we  must 
solve  this  question  ere  we  can  undertake  to  vary  the 
amounts  in  cases  of  disorder. 

Normal  Requisite  of  Tlssuefood. — In  endeavoring  to 
discover  some  rule  for  general  guidance,  it  occurred  to  me 
that,  if  it  be  true  that  growth  is  due  to  the  action  of  liv- 
ing cells  on  albumen,  and  if  the  individual  cell-energy  de- 


XOEMAL    REQUISITE    OF    TISSUE-FOOD,  61 

clines  gradaaliy  from  conception  to  death,  as  it  must  do  if 
it  can  only  live  by  expenditm-e  of  its  store,  that,  per  unit 
of  weight  of  living  tissue,  the  demand  for  albumen  must 
show  a  steady  decline,  quite  irrespective  of  bodily  work, 
during  the  whole  period  of  life.  Every  diet-table,  though 
such  are  founded  only  on  a  practical  basis  and  are  simply 
the  result  of  experiment,  I  found  to  bear  out  the  truth  of 
this.* 

The  mean  of  such  tables  gave  the  following  result,  reck- 
oning for  peojole  of  ordinary  fatness,  for  fat,  not  being 
a  living  tissue,  but  merely  representing  stored  fuel,  must, 
in  cases  of  obesity,  be  allowed  for  in  calculating  bodily 
weight. 

Per  pound  weight,  per  diem,  at  birth  the  demand  is 
about  30  grains,  avoirdupois.  As  life  advances  this  de- 
mand fails  each  year  steadily  at  the  rate  of  from  -|-  to 
J  of  a  grain,  till  in  extreme  old  age  it  has  been  reduced 
to  15  grains  per  pound  weight,  or  but  half  of  that  at 
birth. 

Take  a  young  baby,  say  of  18  lbs.  weight,  and,  according 
to  the  above  rule,  it  will  need  540  grains  of  albumen  per 
diem.  Xow,  each  pint  of  cows'  milk  contains  albumen, 
in  the  form  of  caseine,  to  the  extent  of  about  360  grains, 
and  therefore  1-|  pint  per  diem  will  be  the  normal  daily 
demand,  and  it  is  one  which  experience  confirms  as  sufli- 
cient. 

Of  mother's  milk,  which  is  poorer  in  caseine,  more, 
about  2  pints,  will  be  required. 

Let  us  now  take  the  case  of  an  old  man  of,  say,  the 
weight  of  154  lbs.  (11  stone).  His  demand  per  lb.  weight, 
per  diem,  is  15  grains,  and  thus  the  total  demand  for  his 

*  The  tables  from  which  the  above  calculations  have  been  made 
are  those  of  Drs.  Parkes,  Davy,  Playfair,  De  Chaumont,  Von  Yoit, 
and  Von  Pettenkofer. 


62  THE    PRIXCIPLES    OF    SCIENTIFIC    MEDICINE. 

period  of  life  will  reach  2310  grains,  or  about  5  oz.,  of 
albuminous  food.  This  represents  the  caseine  of  6  pints 
of  milk,  and  accords  with  the  quite  recent  results  of  Dr. 
Germain  See's  investigations,  for  he  reckons  3^  litres, 
almost  exactly  6  pints,  to  be  the  normal  daily  require- 
ments of  albumen  in  old  age. 

It  is  quite  possible  that  my  calculations,  being  based  on 
minimum  necessary  amounts,  may  fall  a  little  below  the 
physiological  needs  in  some  cases,  but  this  does  not  affect 
the  truth  of  this  very  useful  underlying  principle. 

The  demand  for  albuminous  food  is  not  affected,  of 
course,  by  any  conditions  of  work,  of  climate,  of  race,  of 
occupation,  etc.,  all  of  which  have  a  vast  influence  in  mod- 
ifying the  demands  for  fuel-foods  and  water. 

Now  let  us  ask  ourselves  what  are  the  results  respect- 
ively of  an  excess  or  an  undue  lack  of  this  necessary  albu- 
minous material. 

An  excess  over  and  above  the  normal  demands  cannot 
increase  growth  or  favor  renovation  of  tissue,  while  a  defi- 
ciency will  hamper  both  of  these  processes. 

Excess  of  albuminous  food,  all  of  it  that  will  pass  the 
portals  of  digestion,  will  of  course  be  burned,  as  all  albu- 
minous food  is  burned  in  the  liver;  but  if  the  excess  be 
great  or  habitual,  this  oxidation  process  may  be  impaired, 
and  gout  or  biliousness,  as  we  shall  see  later  on,  will  be 
the  direct  result  of  this  overwork  of  the  liver.  But,  sup- 
posing the  liver  equal  to  the  excess,  then,  after  combus- 
tion, the  excess  of  albuminous  food  will  be  cast  out  of  the 
body  by  the  kidneys.  An  excess,  thus,  of  albumen,  while 
it  assists  somewhat  in  maintaining  bodily  heat  and  en- 
ergy, by  virtue  of  the  combustion  process  which  it  must 
undergo,  taxes  severely  the  stomach,  intestines,  liver,  and 
kidneys. 

But  the  cells  in  the  body  of  man  must,  if  they  are  to  ex- 


THE    PLACE    OF    TISSUE-FOOD    IX    DISEASE.  63 

liibit  a  regular  series  of  phenomena  as  an  outcome  of  their 
interaction  with  tissue-food,  be  supplied  prett}^  equally  at 
every  part  of  the  twenty-four  hours  with  albumen.  How 
is  this  equality  of  distribution  to  be  maintained  when  food 
is  taken  but  intermittently  ?  By  a  very  simple  process, 
analogous  to  that  by  which  a  city  is  kept,  both  in  wet  and 
dry  seasons,  supplied  with  water,  by  the  intervention,  be- 
tween the  source  of  suj^ply  and  the  consumers,  of  a  reser- 
voir. The  blood  channels  serve  this  end,  and,  as  we  shall 
see  later  on,  the  fluid  portion  of  the  blood  is  scarce  any- 
thing more  than  a  store  of  digested  albumen,  constantly 
supplying  the  cells  with  their  necessary  amounts,  itself  in- 
termittently fed  by  our  daily  meals;  while  we  shall  also 
find  that  the  liver  acts  similarly  as  a  storehouse  for  fuel- 
food  of  the  starchy  and  saccharine  order,  placed  between 
the  supply  and  the  demand;  while  the  loose  cellular  tissue 
of  the  body  plays  the  same  role  in  reference  to  the  fatty 
foods.  Thus  it  comes  about  that,  provided  a  man  be  sup- 
plied but  with  plenty  of  drinking-water  (which  always 
contains  some  of  the  necessary  inorganic  salts),  he  may, 
while  deprived  of  every  other  form  of  food,  not  only  live 
for  many  days,  but  live  with  a  comparatively  trifling  loss 
of  energy,  especially  if  he  be  kept  at  rest  and  warm,  for 
when  at  rest  but  little  fuel-food  is  consumed,  as  the  de- 
mand for  heat-energy  is  small,  while  a  warm  atmosphere 
prevents  any  but  the  most  trifling  loss  by  radiation  from 
the  body  to  the  surrounding  air. 

But  to  return  to  our  tissue-food.  We  have  seen  what 
the  rule  of  the  health  supply  is,  let  us  discuss  in  what  way 
this  rule  is  modified  by  the  presence  of  disease. 

T/ie  Place  of  Tissue-food  (Albumen)  in  Disease. — The 
human  body  being,  as  we  saw  in  our  first  chapter,  not  a 
vast  compound  of  beings,  but  a  single  individual,  a  unit, 
between  each  of  which  parts  there  is  such  close  relation- 


64  THE    PKIXCIPLES    OF    SCIENTIFIC    MEDICINE. 

ship  that  when  one  cell  thereof  is  thrown  off  (in  genera- 
tion), it  bears  in  it  the  impress  of  the  whole  body  down 
even  to  its  minutiae,  there  cannot  be,  as  in  fact  there  is  not, 
such  a  thing  as  local  disease.  The  cells  of  one  part  may 
die  or  weaken  before  those  of  another,  by  reason  of  extra 
strain  or  of  inherited  debility,  but  to  imagine  that  in  a 
perfect  mechanism  like  the  body,  all  of  whose  parts  arc 
interdependent,  none  of  whose  parts  are  de  trop,  one  atom 
even  can  be  lost  without  the  whole  body  feeling  and  shar- 
ing in  the  loss,  though  our  perceptions  may  not  be  fine 
enough  to  allow  us  to  discern  it,  nor  our  microscopes  potent 
enough  to  be  able  to  measure  it,  is  a  physical  absurdity  to 
which  no  thouo:htful  man  will  subscribe. 

All  disease  is  therefore,  perforce,  general,  though  it  is 
naturally  the  organs  most  allied  in  function  or  most  ap- 
proximated in  position  to  the  seat  of  greatest  disorder,  to 
the  so-called  local  malady,  that  share  most  in  the  mani- 
festations of  derangement. 

All  bodily  disorders — some  more,  some  less — interfere 
with  the  great  function  of  nutrition,  that  one  function 
which  every  organ  of  the  whole  body  is  built,  directly  or 
indirectly,  but  to  subserve.  Disease  always  hinders,  when 
severe  is  said  by  competent  authorities  even  to  arrest,  the 
action  between  living  cells  and  their  tissue-food,  the  cells 
in  the  cases  of  arrest  seeming,  by  the  imbibition  of  water 
and  salts,  themselves  to  nndergo  a  series  of  chemical 
changes  which  serve  to  maintain,  but  of  course  for  a  short 
time  only,  an  imperfect  life.  Personally,  I  do  not  believe 
that  actual  arrest  of  the  assimilation  process  by  cells  ever 
occurs,  can  ever  occur,  in  a  living  body,  but  there  can  be 
no  doubt  but  that  in  severe  fevers  the  power  of  assimila- 
tion falls  very  low  indeed.  This  impediment  to  assimila- 
tion of  tissue-food  in  all  disease  is  a  cardinal  fact  to  be  re- 
membered, and  the  one  on  which  the  dietetic  management 


THE    PLACE    OF   TISSUE-FOOD    IN    DISEASE.  65 

of  all  disorder  is  to  be  built.  Concurrently  with  it,  and 
proportionately  to  it,  and  also  as  a  consequent  of  the  bodily 
derangement,  the  digestive  powers  fail. 

In  mild  bodily  disorders,  and  the  best  general  guide  we 
possess  to  the  mildness  of  a  disease,  though  it  is  but  a 
rough  one,  is  the  clinical  thermometer,  we  therefore  di- 
minish the  total  quantity  of  tissue-food  given,  and  we  give 
it  in  the  most  simple  form  and  with  plenty  of  fluid.  The 
simplicity  of  form  serves  two  purposes  :  first  of  all  it  taxes 
less  the  muscular  poicers  of  the  digestive  organs,  a  very 
important  and  essential  part  of  the  digestive  process,  and 
one,  of  course,  also  weakened  in  disease  ;  secondly,  it  en- 
ables any  amount  given  in  excess  of  the  digestive  capacity 
to  pass  off  by  the  intestine  in  a  shape  likely  to  cause  that 
structure  least  irritation,  and  also  least  likely  to  ferment 
and  generate  troublesome  gases. 

For  these  reasons  we  administer  in  mild  febrile  disorders, 
those  in  which  the  temperature  rises  to  100°  or  101°  F., 
semi-solid  albuminoids  and  semi-solid  foods  in  general, 
soups — of  which  milk,  cheese,  meat,  fish,  or  seeds,  such  as 
lentils  or  beans,  form  the  main  albuminoid  basis — and  milk 
puddings,  the  ingredients  in  which  are  slowly  and  thorough- 
ly cooked  and  not  bound  together  by  egg  albumen.  Then 
we  often  allow  ripe  fruits,  especially  such  as  are  rich  in 
grape-sugar,  and  also  easy  of  digestion.  We  always  give 
plenty  of  water.  Finally,  we  possess  various  important, 
and  indirectly  highly  useful,  pseudo-foods,  alcohol,  gela- 
tine, tea,  coffee,  etc.,  which  possess,  according  to  eminent 
authorities,  a  certain  poAver  in  arresting  the  denutrition  of 
cells,  and,  while  not  actually  foods,  are,  like  the  fire-bricks 
placed  in  some  grates,  economizers  of  fuel. 

In  severe  disease,  when  the  temperature  mounts,  and  in 
proportion  as  it  mounts,  to  104°  F.,  or  higher,  we  decrease 
the  amount  of  albumen  given  as  food,  while  we  exercise 


66  THE    PRINCIPLES    OF    SCIENTIFIC   MEDICINE. 

greater  caution  as  to  the  form  in  which  we  give  it,  and  we 
increase,  on  the  whole,  the  amount  of  water  and  salts. 
We  make  our  soups  and  meat  essences  thinner,  we  often 
have  to  do  away  even  with  the  milk  puddings  as  being 
too  great  a  tax  on  the  exceedingly  restricted  digestive 
powers,  substituting,  for  the  starch  and  sugar  which  they 
contain,  fruit  drinks  or  even  grape-sugar  dissolved  in  water. 
We  take  equal  or  even  greater  precautions  as  regards  the 
fats,  trusting  to  the  cream  in  ordinary  milk  as  the  sole 
fat  likely  to  pass  the  digestive  processes.  For  above  all 
we  dread,  by  an  injudicious  administration  of  over-much 
food,  to  impair  further  the  performance  of  the  digestive 
acts. 

In  the  most  severe  of  our  cases,  those  in  which  we  have 
reason  to  think  that  all,  or  nearly  all,  cell  assimilation  is 
at  a  standstill,  our  reliance  falls  on  water,  and  the  salts  it 
contains,  no  mean  food  under  the  circumstances,  for  it  can, 
by  dissolving  any  remains  of  healthy  albumen  in  the  blood- 
stream, carry  this  on  to  the  cells  when  all  digestion  is  in 
abeyance.  In  this  bad  pass  we  may  also  turn  hopefully 
to  whey,  and  to  infusions  of  tea  and  coffee,  to  gelatine, 
and  above  all  to  alcohol,  which  latter,  in  very  tiny  doses 
only  (a  teaspoonful  of  whiskey  every  hour  is  about  the 
limit),  but  not  in  large  ones,  has  apparently  some  power 
of  arrest  over  the  denutrition  of  the  cells.  The  large 
doses,  often  administered,  cannot  do  this  ;  they  can  only 
stimulate,  rouse  the  cells  to  emit  that  little  last  residue  of 
energy,  on  the  economizing  of  which  rest  our  last  hopes  of 
recovery. 

Normal  JRequisite  of  Fuel-foods. — This  may  be  briefly 
stated  in  the  two  following  aphorisms  : 

Per  unit  weight  of  living  body  tissue,  there  is  a  slight, 
but  well-marked,  decrease  in  the  normal  demand  for  fuel- 
food  from  birth  to  death. 


NORMAL    REQUISITE    OF    FUEL-FOODS.  67 

But  this  demand  is  affected  (within  the  limits  of  the 
digestive  capacities)  by  the  amount  of  work  performed — 
i.  e.,  by  the  necessity  for  more  heat-energy  when  much 
muscular  work  has  to  be  done — and  by  the  loss  of  heat  by 
radiation  from  the  body,  the  demand  rising  in  cold  weath- 
er, and  when  articles  of  attire  that  are  good  conductors  of 
heat  are  worn. 

It  is  seen,  therefore,  that  this  second  rule  will  not  permit 
of  our  representing  the  demand  for  fuel-foods,  as  that  for 
tissue-foods,  as  an  even  descent  throughout  life,  for  the 
downward  grade  is  often  temporarily  interfered  wdth  by 
extra  demands  for  heat-energy  to  perform  extra  w^ork, 
and  by  questions  of  air,  temperature,  and  of  clothing. 

Both  of  the  above  rules  appeal  at  once  to  our  reason, 
for,  as  regards  the  first,  it  is  clear  that  as  the  cells  of  the 
body  decline  in  vitality,  so,  in  proportion  to  such  decline, 
must  be  their  limit  of  storing  heat-energy  ;  while  as  re- 
gards the  second,  it  is  evident  that  if  heat-energy  be  the 
body's  great  motor-power,  the  supply  of  fuel  must  rise 
with  the  work  to  be  done,  and  with  the  greater  losses  by 
radiation  from  the  body. 

The  dangers  attendant  on  an  excess  in  the  consumption 
and  absorption  of  fuel-foods  are  those  which  follow  on 
obesity,  for  such  excess  is  deposited  in  the  cellular  tissues 
of  the  body  as  fat.  When  this  deposit  passes  certain  lim- 
its it  affects  by  its  weight  and  pressure  the  muscular  tis- 
sues, rendering  exertion  difficult,  and  thus,  unless  some 
wise  dietetic  restrictions  are  taken,  directly  conduces  to 
even  greater  deposits,  until  eventually  the  breathing  pow- 
ers and  the  heart's  action  become  seriously  embarrassed. 

A  deficiency  in  the  necessary  fuel-supply  of  the  body 
causes  loss  of  energy,  and  indeed  one  of  the  commonest 
troubles  of  advancing  age,  depression  of  spirits  and  in- 
ability for  exertion,  is  often  successfully  combated  by  the 


68  THE    PKIXCIPLES    OF    SCIENTIFIC    MEDICINE. 

administration  of  easily  digested  fats.  In  addition  it  leads, 
at  all  ages,  but  particularly  in  the  young,  and  for  special 
causes  to  be  mentioned  in  the  second  part  of  this  work,  to 
risk  of  lung  disease. 

The  Place  of  Fuel-food  in  Disease. — Since  fuel-food,  by 
which  we  mean  the  starches  and  sugars  (the  carbo-hydrates) 
and  the  fats  (the  hydro-carbons),  is,  as  compared  with  albu- 
men, of  simple  structure,  and  does  not  undergo,  as  does  the 
latter,  with  the  molecules  of  the  body-cells  any  known 
chemical  change,  it  would  at  first  sight  seem  that  in  dis- 
ease we  might,  provided  we  did  not  exceed  the  digestive 
capacity,  hope  for  very  great  help  from  a  free  administra- 
tion of  it.  To  a  great  extent,  however,  the  vitality  of  the 
cells  determines  the  amount  of  possible  combustion  of  these 
foods,  for,  while  there  is  strong  reason  to  think  that  the 
oxygen  carried  by  the  red- blood  corpuscles  and  the  fuel- 
foods  meet,  and  by  so  doing  evolve  their  heat-energy  with- 
in the  cell-substance,  it  is  certain  that  the  cells  store  the 
heat-energy,  and  that  their  storage  power  is  decreased  by 
all  forms  of  derangement.  For  these  reasons  much  the 
same  rules,  guarded  by  much  the  same  precautions,  must 
govern,  in  disease  as  in  health,  the  administration  of  both 
tissue  and  fuel  foods. 

But  the  fuel-foods  are  of  two  kinds,  hydrates  of  carbon 
— i.  e.,  the  starches  and  sugars,  from  which  relatively  but 
little  energy,  and  that  from  the  oxidation  of  th^  carl)on 
only,  can  be  drawn — and  hydro-carbons — ^.  6.,  fats,  sub- 
stances which  yield  for  combustion  not  only  carbon,  but 
also  a  large  quantity  of  hydrogen,  an  element  from  the 
combustion  of  which  latter  more  heat  can  be  evolved  than 
from  any  other  element.  For  these  reasons  the  fats  are, 
as  fuels,  worth  nearly  double  their  weight  of  starches  or 
sugars,  and  there  would  seem  a  strong  d  jyriori  reason  for 
their  employment  in  illness.     Unfortunately,  the  teaching 


WATER    AND    SALT    IN    DISEASE.  69 

of  practical  experience  seems  to  indicate  that  the  difficulty, 
even  in  health,  of  digesting  fats  is  much  greater  than  that 
of  digesting  hj^drates  of  carbon,  and,  as  we  shall  see  fur- 
ther on,  the  process  of  digestion  in  the  two  cases  is  also 
very  different. 

Thus  it  happens  that  in  states  of  disease  we  have  to  ex- 
ercise, in  regard  to  the  fuel-foods,  much  the  same  care  as 
in  the  matter  of  the  tissue-foods,  selecting  from  them  the 
substances  most  easy  of  digestion,  and  administering  these 
in  a  simple  and  liquid  form.  Among  the  fats,  cream  and 
butter  are  the  most  palatable  and  easy  of  digestion,  but 
their  taste  must  often  be  disguised,  and  they  must  be  ad- 
ministered only  in  free  dilution.  In  the  case  of  the  starches 
and  sugars,  the  former  well  cooked  in  the  form  of  farina- 
ceous puddings  with  milk,  but  without  eggs,  are  of  great 
use  in  mild  cases  of  illness,  but  they  are  very  badly  borne 
when  the  bodily  temperature  is  high.  Here,  again,  whey, 
by  reason  of  its  richness  in  sugar-of-milk,  is  often  useful, 
or  a  malt  extract,  which  may  be  generally  reckoned  on  as 
being  pure  grape-sugar,  may  be  given  in  barley  or  lemon 
water.  Short  detailed  hints  will  be  found  in  the  Appen- 
dix, to  which  I  must  refer  the  reader  for  fuller  informa- 
tion as  to  sick  dietary. 

The  Normal  Requisite  of  Water  and  /Salts. — As  to  the 
necessary  daily  needs  of  the  body  in  regard  to  water  we 
have  no  rule,  nothing  much  beyond  our  instinct,  nearly 
always,  by  the  way,  a  very  efficient  guide,  to  direct  us.  If 
the  suppl}^  of  this  fluid  fall  below  the  necessary,  the  actiAnty 
of  the  cells  and  their  heat-storage  power  will  both  suffer, 
for  only  when  in  solution  with  Avater  can  albumen  and 
fuel-foods  serve  their  ends  in  the  body.  A  deficiency  in 
water  supply  will  tell  also  in  another  way,  for  the  waste 
products  that  should  pass  out  by  the  kidneys  having  also 
to  be  kept  in  a  dissolved  state,  it  follows  that  elimination 


10  THE    PRINCIPLES    OF    SCIENTIFIC    MEDICINE. 

by  these  channels  will  be  interfered  with,  and  certain  dis- 
eases, especially  gout  and  rheumatism,  will  then  menace 
the  body. 

The  various  necessary  salts  of  the  body,  of  which  com- 
mon salt  is  the  chief,  are  but  seldom  consumed  in  excess, 
and  then  they  appear  often  to  produce  skin  affections. 
Any  deficiency  in  the  supply  of  them  is  attended  by  much 
more  grave  mischief,  by  a  general  interference  with  the 
assimilation  of  food  and  by  local  changes  in  the  kidneys,, 
skin,  and  bones. 

27ie  Place  of  Water  and  Salts  in  Disease  is  an  impor- 
tant one.  We  have  seen  that  by  the  free  administration 
of  water  alone,  life  may  be  prolonged  for  many  days,  and 
when  we  consider  that  starvation  is,  in  nearly  all  disease, 
the  final  cause  of  death,  we  shall  not  be  likely  to  under- 
value it  as  a  potent  aid  in  the  combat  with  grave  dis- 
ease. 

Food  Accessories. — Tea,  coffee,  coca,  and  cocoa  each 
contain  within  them  a  substance  which  apparently  has  the 
effect  of  lessening  cell  waste.  Used  with  discretion  they 
are  therefore,  especially  in  disease,  valuable  dietetic  aids. 
Alcohol,  in  very  small  quantities,  is  also  serviceable  in  a 
similar  way.  Condiments,  such  as  mustard,  pepper,  etc., 
are,  in  civilized  races,  useful,  and,  by  reason  of  habit,  often 
necessary  adjuncts  to  food.  They  are  not,  as  ignorantly 
asserted  by  certain  hygienists,  stimulants,  but  have  be- 
come of  the  nature  of  the  ordinary  forces  in  the  environ- 
ment of  civilized  man,  though  in  the  lower  animals  they 
act  as  local  stimulants  simply  because  these  latter  are  not 
of  a  race  habituated  as  yet  to  their  use. 

Artificial  Digesting  Agents. — In  what  I  hold  to  have 
been  a  singularly  unlucky  day  for  posterity,  Dr.  Eberle, 
rather  more  than  half  a  century  ago,  first  separated  froiu 
the  stomach  of  the  pig  its  special  digestive  ferment,  pep- 


ARTIFICIAL   DIGESTING   AGENTS.  Vl 

sin.  Here  was,  in  truth,  a  crutch  for  the  crippled  stomach 
of  the  dyspeptic;  in  this  substance  surely  lay  the  hope  of 
bringing  food  to  the  starving  cells  of  the  fever-smitten  ! 
So  thought  the  public,  and  those  of  the  medical  world 
whose  enthusiasm  outran  their  knowledge  of  physiology. 
The  debilitated  stomach  got  weaker,  more  hopelessly  un- 
equal to  work,  by  leaning  on  the  support  of  pepsin,  while 
the  deranged  stomach  of  the  fever-smitten,  taken  at  a  dis- 
advantage, let  slip  sometimes  through  its  coats  the  arti- 
ficially digested  food,  and  hampered  with  it  the  body-cells 
— starving  not  for  want  of  food,  but  because  they  could 
not  eat — and  often  blocked  the  struggling  kidneys,  end- 
ing the  life  of  the  patient  by  the  vast  increase  of  nitroge- 
nous waste  thus  intruded  on  the  blood-stream. 

Since  its  discovery  pepsin  has  had  a  host  of  colleagues 
and  rivals  :  trypsin,  pancreatin,  diastase,  etc.,  all  ready  to 
the  hand  of  him  who  thinks  that  the  aim  of  medicine  is  to 
thwart  and  circumvent  the  operations  of  Nature,  because 
such  operations,  in  the  case  of  disease,  are  sometimes  un- 
intelligible to  him.  Long  since  the  great  chemist,  Liebig, 
gave  birth  to  a  vast  truth  when  he  said  that  "  Nature  re- 
fused to  be  made  the  handmaid  of  chemistry."  There 
are,  however,  rarely  occurring  emergencies,  as  we  shall  see, 
Avhen  artificial  digesters  afford  us  a  temporary  aid,  but  this 
accommodation  has  even  then  to  be  subsequently  and  dear- 
ly paid  for. 

Any  necessary  special  modifications  of  food  in  disorders 
such  as  gout,  dyspepsia,  etc.,  will  be  dealt  with  when  the 
treatment  of  those  disorders  comes  in  question. 

Brief  as  has  then  been  our  survey  of  the  foods,  it  has 
suflSced  to  raise  in  our  minds  a  strong  susj^icion  that  many 
disorders  of  man  may  be  due  to  a  deficiency  or  an  excess 
in  this,  the  greatest  factor  in  what  we  call  the  environ- 
ment of  man.     Let  us  now,  under  the  heading  of  climate, 


-    72  THE    PRINCIPLES    OF    SCIENTIFIC   MEDICINE, 

view  the  part  that  may  be  played  by  atmospheric  air  in 
the  maintenance  or  the  restoration  of  health. 

II.   Climate. 

The  question  of  climate  resolves  itself  mainly  into  an 
examination  of  the  air,  and  of  the  effects  which  the  differ- 
ent airs  exert  on  the  body  of  man. 

Parity,  temperature,  moisture,  force,  and  direction  are 
the  qualities  of  air. 

{a)  The  Purity  of  Air. — The  average  air  may  be  said 
to  consist  of  an  admixture  of  \  oxygen  gas  and  of  nearly 
^  nitrogen  gas,  the  small  balance  being  made  up  of  wa- 
ter, vapor,  carbonic  acid,  and  various  other  solid  and  gas- 
eous ingredients.  The  oxygen  may  exist  either  in  the 
form  of  the  ordinary  gas  (Og),  or  in  the  condensed  and 
unstable  form  of  ozone  (O3),  which  latter  parts  readily, 
when  in  contact  with  anything  oxidizable,  with  the  third 
atom  of  its  molecule,  and  thus  like  oxygen,  but  to  a  yet 
greater  extent,  assists  decay  oci  the  conversion  of  the  or- 
ganic to  the  inorganic,  while  in  living  beings  that  inhale 
it  in  small  quantities,  it  assists  the  combustion  of  their 
fuel  foods,  acting  thus  as  a  mild  stimulus  in  the  produc- 
tion of  energy.     . 

Nitrogen  gas  in  the  air  plays,  as  far  as  its  discoverable 
influence  on  the  body  of  man  is  concerned,  the  part  of  a 
diluent  to  the  oxygen.  The  relative  amount  in  air  of  car- 
bonic-acid gas,  the  amount  of  which  varies  from  3  to  6 
parts  in  10,000  parts  of  air,  is  apparently  only  of  impor- 
tance to  man  inasmuch  as  with  its  proportionate  rise  is 
there  remarked  a  change,  a  development,  in  certain  very 
interesting  inhabitants  of  all  air,  the  bacteria. 

The  bacteria— in  which  term  I  include  the  globular  mi- 
crococci, the  long  bacilli,  the  short  bacteria?,  and  the  spiral 
spirilla} — are  the  natural  inhabitants  of  the  air,  and  are 


THE  TEMPEEATUKE    OF    THE    AIR.  73 

probably  of  a  vegetable  nature.  Their  one  function  is  to 
cause  fermentation  in  dead  or  enfeebled  organic  matter — 
in  other  words,  they  are  the  agents  of  decom2)osition. 
Like  everything  else  that  has  life,  the  bacteria  may  be  al- 
tered in  structure,  and  consequently  in  power  and  func- 
tion, by  their  environment.  It  is  on  them  that  the  differ- 
ence in  the  composition  of  the  air  in  various  places  tells, 
and  through  changes  thus  produced  in  them,  that  man  is, 
in  a  secondary  and  indirect  manner,  affected  by  what  is 
termed  impurities  of  the  air.  The  ordinary  bacteria,  the 
inhabitants  of  the  air  of  open  spaces,  have  no  power  to 
hurt  the  bodies  of  living  animals;  not  that  the  bacteria  are 
providentially  designed  not  to  affect  these,  but  because 
the  ordinary  bacteria,  like  the  other  ingredients  of  ordi- 
nary air,  are  one  of  the  usual  forces  in  an  animal  environ- 
ment, a  force  probably  not  only  innocuous  but  beneficial. 
But  new  and  strange  conditions — as  those  which  result 
from  overcrowding — produce  novel  changes  in  the  air,  and 
novel  varieties  of  bacteria,  and  these  novel  varieties  rep- 
resent a  novel  force — one  unbalanceable  by  men  and  ani- 
mals unaccustomed  to  them — which  does  not,  of  course, 
spare  living  tissue,  but  sets  up,  even  within  it,  a  fermen- 
tation which  is  called  fever.  Once  formed,  these  novel 
bacteria,  provided  their  surroundings  be  favorable,  live 
and  23ropagate  themselves.  Incredible  as  may  seem  to  the 
lay  reader  the  above  statements,  they  are  nearly  all  de- 
monstrable by  actual  experiment. 

{h)  The  Temperatureofthe  Air, — Almost  the  sole  source 
of  atmospheric  heat  is  the  sun.  Dry  air,  however,  is  so 
diathermic — ^.  e.,  allows  radiant  heat  to  pass  so  readily 
through  it — that  it  is  only  in  proportion  to  the  water- 
vapor  present  that  air  can  be  much  affected  by  direct 
solar  rays;  in  point  of  fact,  the  main  source  of  the  tem- 
perature of  the  air  is  quite  indirect,  and  due  to  heat  im- 
4 


74  THE    PRINCIPLES    OF    SCIENTIFIC    MEDICINE. 

parted  to  it  by  the  solid  and  liquid  substances  of  which 
the  upper  earth  crust  consists,  and  Avhich  have  first  ab- 
sorbed, and  then  imparted  to  the  air,  the  heat  of  the  direct 
solar  rays. 

But  the  reflected  sun-rays  from  light  soils,  from  sheets 
of  water,  and  even  from  snow-fields,  are  also  sources  of 
atmospheric  heat.  To  the  reflection  from  the  neighboring 
snow-fields,  Davos  and  Saint  Moritz  owe  largely  their  high 
winter  temperature;  and  to  that  from  the  sea,  the  winter 
health-resorts  on  the  south  of  the  Isle  of  Wight  are  main- 
ly indebted  for  a  like  result. 

But  water  plays,  in  the  distribution  of  heat,  other  very 
important  roles.  Water  absorbs  heat  more  than  does 
land,  and  by  reason  of  this  and  of  the  rising  of  the  low- 
er, warmer  strata,  when  its  surface  cools,  it  has  a  more 
permanently  warming  effect  on  the  superjacent  air  than 
land.  Moreover,  water  is  fluid,  and,  as  a  result  of  the  ine- 
quality of  sun-heat  in  the  different  portions  of  the  earth,  is 
kept  constantly  in  motion.  Thus  the  two  great  ocean  cur- 
rents, that  of  warm  surface  water  from  the  equator  to  the 
poles,  and  that  of  deeper  cold  water  from  the  poles  to  the 
equator,  are  formed.  The  first  of  these  exerts  a  great  in- 
fluence in  raising  the  mean  winter  temperature  of  certain 
portions  of  land  exposed  to  its  full  influence  to  a  point 
which  their  latitude  alone  would  by  no  means  entitle  them 
to.  Then,  again,  the  winds  that  come  to  us  in  winter  from 
over  extensive  tracts  of  sea,  like  our  w^est  and  southwest 
winds,  though  moist,  are  warm,  while  the  east  and  north- 
east winds  at  that  time  of  year  are  cold,  travelling  as  they 
do,  before  they  reach  us,  over  extensive  tracts  of  land  that 
have  long  since  lost  all  the  heat  derived  from  their  sum- 
mer sun. 

The  relative  position  of  mountain-chains  and  the  pro- 
tection thev  afford  against  cold  winter  winds,  again  affects 


HUMIDITY    OF    THE    AIR.  75 

very  considerably  the  mean  winter  temperature,  while  ele- 
vation above  sea-level,  and  many  other  minor  conditions, 
further  influence  it. 

The  effects  of  even  hot  direct  solar  rays,  if  the  air  be 
dry,  are  not  much  to  be  feared,  and  are  rarely  productive 
of  sunstroke.  If,  however,  much  moisture  be  present,  the 
risks  from  the  latter  disorder  are  very  great  if  much  exer- 
tion be  undertaken,  and  this  not  only  when  the  individual 
is  exposed  to  the  direct  rays  of  the  sun,  but  even  while  he 
remains  in  shade. 

(c)  Humidity  of  the  Air. — The  habitual  presence  of  an 
excess  of  water- vapor  in  the  air  is  traceable  as  a  rule  to 
one  of  two  conditions — the  neighborhood  of  large  masses 
of  water,  especially  of  fresh  water,  and  the  nature  of  the 
soil. 

Although  the  former  of  these  might  seem  to  have  by 
far  the  more  important  effect  on  the  air  and  on  the  human 
beings  that  breathe  it,  the  opposite  is  actually  the  case,  for, 
providing  the  air  currents  are  not  cut  off  by  the  shelter  of 
surrounding  hills,  and  the  houses  be  raised  well  above  the 
highest  flood  mark,  the  residents,  even  those  much  influ- 
enced by  the  presence  of  an  excess  of  watery  vapor  in  the 
air,  are  not  very  specially  subject  to  the  ailments  which 
are  apt,  in  people  of  certain  constitution,  to  follow  ex- 
posure to  damp. 

A  damp  and  ever-perspiring  soil  is,  however,  a  potent 
factor  in  bringing  out  rheumatism,  gout,  bronchitis,  phthi- 
sis, catarrhs,  and  in  actually  developing  more  dreaded  dis- 
orders, such  as  English  cholera,  ague,  dysentery,  crou}". 
and  diphtheria. 

By  a  damp  soil  is  understood  one  which  is  more  or  less 
impermeable  to  water.  Clay  is  one  great  example  of  such. 
Not  that  the  clay  stands  out  conspicuous  to  the  eye,  ex- 
cept, perhaps,  in  patches  here  and  there;  it  is  covered  usu- 


76  THE    PRINCIPLES    OF    SCIENTIFIC    MEDICINE. 

ally  by  a  few  inches  or  feet  of  alluvial  soil,  which  rests 
upon  what  is  called  a  bed,  a  subsoil,  of  clay.  Sometimes 
a  stratum  of  sand  or  gravel,  several  feet  in  thickness,  may 
be  interposed  between  the  two  above-mentioned  layers, 
masking  to  the  eyes  of  superficial  observers  the  real  char- 
acter of  the  ground.  Whatever  the  nature  of  the  upper- 
most layer  or  layers,  provided  there  be  a  subsoil  of  clay 
thick  and  tenacious  enough  to  prevent  the  passage  through 
it  of  water,  and  the  level  position  of  the  clay-bed  be  such 
that  the  water  cannot  run  off,  the  soil  will  be  a  damp  and 
also  a  cold  one. 

We  can  readily  understand  that  such  a  soil,  always 
moist,  always  perspiring  under  the  influence  of  solar  heat, 
must  keep  the  superjacent  air  ever  full  of  moisture,  and 
must  predispose  to  such  disorders  as  rheumatism,  gout, 
etc.;  but  the  method  in  which  it  can  actually  breed  cer- 
tain germ  diseases,  such  as  dij^htheria,  demands  some  fur- 
ther explanation. 

The  upper  layers  of  all  land  contain  vegetable  or  animal 
organic  matter  in  a  state  of  decomposition — i.  e.,  loaded 
with  bacteria  more  or  less  developed,  according  to  the 
pabulum  on  which  they  feed,  the  amount  of  air  or  moist- 
ure in  the  soil,  etc.  Now,  in  a  dry  soil  the  rain-water 
passes  through  this  layer,  carrying  downioards  all  such 
animal  life.  In  a  damp  soil  the  moisture  from  the  upper 
sodden  layers  has  to  reappear  shortly  in  the  form  of  per- 
spiration from  the  ground,  and  such  perspiration  brings 
up  with  it  many  of  these  bacteria.  Much  will  depend 
upon  the  atmospheric  conditions  whether  these  bacteria 
develop  further,  or  remain  as  they  are,  or  die.  During 
summer  heats  they  apparently  undergo  changes  which  con- 
vert them  to  the  germs  of  English  cholera  and  of  dysen- 
tery; in  damp,  cold,  stagnant  atmospheric  states  into  the 
germs  of  diphtheria,  croup,  pneumonia,  etc.     We  all  know 


HUMIDITY    OF    THE    AIR.  11 

liow  certain  places  are  insalubrious  at  certain  times  of  the 
year. 

But  a  clay  subsoil  need  not  always  be  equally  a  damp 
one.  If  the  drainage  be  deep  and  good,  or  if  the  clay  bed 
slope,  much  of  the  surface  water  will  be  carried  off,  and 
the  soil  will  be  drier.  Some  clays  are,  again,  more  imper- 
meable than  others — that  which  underlies  a  large  portion 
of  London  is  less  tenacious  in  composition  than  that  found 
so  extensively  in  the  eastern  counties. 

We  have  seen  that  either  gravel  or  sand  may  overlie  a 
bed  of  clay;  but,  independently  of  this  state  of  matters,  a 
low-lying  gravel  soil  near  a  large  river  is  to  be  always 
strongly  suspected,  for  such  is  often  sodden  with  water 
and  far  damper  and  more  dangerous  than  the  worst  clay  soil. 

Speaking  generally,  a  chalk  subsoil  is  the  best  and  driest, 
next  in  order  coming  gravel  and  sand,  and  then  a  sloping, 
well-drained  clay  bed. 

We  must  content  ourselves  with  this  very  brief  survey 
of  a  large  subject,  and  pass  on  at  once  to  inquire  what  are 
the  effects  on  man  of  much  moisture  in  the  air. 

Dry  air  is  a  bad  conductor  of  heat,  moist  air  a  good 
one  ;  a  dry,  cold  air  has  therefore  far  less  effect  on  the 
body,  and  is  much  more  easily  borne  by  it,  than  a  moist 
one  of  equal  temperature.  A  warm,  dry  air  favors  perspi- 
ration, and  induces  a  high  state  of  assimilative  activity  in 
the  body.  A  warm,  moist  air  checks  tissue  change,  and 
thus,  other  conditions  being  equal,  tends  to  produce  both 
lethargy  and  to  favor  increase  in  weight.  Thus,  formerly, 
warm,  moist  airs  were  in  repute  for  all  wasting  diseases, 
such  as  consumption,  but  at  the  present  day  less  warm,  but 
drier,  airs  are  recommended,  and  are  found  indirectly,  by 
increasing  the  vigor  of  the  bodily  functions,  to  conduce  in 
such  diseases  to  an  increase  in  bodily  weight,  as  well  as  to 
bodily  vigor. 


78  THE    PRINCIPLES    OF    SCIENTIFIC    MEDICINE. 

Sir  James  Clark  deliberately  says  :  "  Of  all  the  physical 
qualities  of  air,  humidity  is  the  most  injurious  to  human 
life."  Prostration  of  strength,  depression  of  spirits,  a 
wearying  heaviness,  deficient  appetite,  and  disinclination 
to  bodily  and  mental  vigor,  are  the  symptoms  which  are 
complained  of  by  those  who,  unsuited  to  such  air,  are 
compelled  by  force  of  circumstances  to  reside  in  a  humid 
atmosphere.  Those  of  the  nervous  and  sanguine  temper- 
ament are,  however,  often  fairly  well  in  damp,  relaxing 
airs  ;  the  gouty,  the  rheumatic,  the  bilious,  the  lymphatic 
of  temperament,  are  generally  the  worst  sufferers.  Innu- 
merable diseases  have  been  ascribed  to  a  moist  air;  some 
are  actually  generated  in  the  damp  soil;  some  are  merely'- 
favored  by  the  presence  of  much  atmospheric  moisture. 
Rheumatism,  gout,  heart  disease,  bronchitis,  pneumonia, 
pleurisy,  hypochondriasis,  dysentery,  diphtheria,  typhoid 
fever,  puerperal  fever,  and  even  cancer,  have,  each  and  all, 
by  eminent  medical  authorities,  been  traced  to  the  influ- 
ence of  damp.  Such  sweeping  assertions  must,  however, 
be  received  with  caution,  for  it  is  only  on  those  whose  cor- 
poreal conditions  demand  a  dry  air  that  damp  can  tell  ad- 
versely, and,  as  a  matter  of  fact,  large  and  healthy  popula- 
tions cover  some  of  the  dampest  soils  in  England. 

Finally,  it  is  well  to  note  that  much  will  depend  upon 
the  construction  of  his  house  as  to  whether  the  resident 
on  a  clay  soil  will  become  painfully  aware  of  the  moist- 
ure that  it  holds.  The  well-built  portions  of  the  west 
of  London  that  rest  on  clay  are,  if  relaxing,  still  whole- 
some, while  the  extensive  areas  in  the  same  district,  cov- 
ered by  the  works  of  the  jerry-builder,  are  infested  with, 
among  other  complaints,  diphtheria  in  cold  weather  and 
English  cholera  in  hot  weather,  firmly  established  as  epi- 
demic disorders. 

Force  and  Direction  of  the  Air  Currents. — As  most  of 


HABITS    AND    MODES    OF    LIFE.  79 

my  readers  already  know,  winds  are  produced  by  the  un- 
equal heating  of  the  air  in  different  parts  of  the  earth, 
and  are,  in  fact,  magnified  draughts. 

Passing  over  the  foreign  windy  celebrities,  such  as  the 
Fohn  of  Switzerland,  the  Khamsin  of  Egypt,  the  Sirocco 
of  IS'orth  Africa  and  Southern  Europe,  the  Bora  of  the 
Adriatic,  and  the  Mistral  of  the  South  French  coast,  we 
have  but  space  to  say,  in  reference  to  the  winds  that  visit 
Great  Britain,  that  the  north  wind  is  moderately  dry,  and 
for  obvious  reasons  nearly  always  cold;  the  east  and  north- 
east winds  are  cold  and  dry  in  the  winter,  hot  and  dry  in 
the  summer;  the  south  wind  is  moderately  warm  and  usu- 
ally dry,  while  the  west  and  southwest  winds,  coming 
over  wide  ocean  tracts,  are  warm  and  moist,  especially  in 
winter,  and  as  the  air  of  the  land  is  cooler,  large  part  of 
their  moisture  is  condensed  into  clouds  and  rain,  much 
latent  heat  being  liberated  in  the  process.  To  this  influ- 
ence is  traceable  the  warm  wet  winters  of  Ireland  and  of 
the  western  shores  of  England  and  Scotland. 

III.  Habits  and  Jlodes  of  Life. 

That  these  have  an  important  bearing  on  individual 
health,  and  therefore  furnish  the  physician,  when  wisely 
and  cautiously  used,  as  levers  in  re-equilibration — i.  e.,  in 
the  restoration  of  health — no  one  can  doubt. 

Spite  of  such  authorities  as  Drs.  B.  W.  Richardson, 
Partes,  De  Chaumont,  Wilson,  and  Farr,  whose  names  are 
familiar  to  all  who  dip  into  the  subject  of  general  sanita- 
tion, there  are  very  few  unhealthy  trades  and  occupations. 
These  authorities  often  fall  into  the  fallacy  of  dealing 
with  the  average  man,  the  standard  man,  and  their  re- 
searches have  therefore  usually  no  practical  bearing  on 
individual  health,  and  are  worse  than  useless  for  the  pur- 
poses of  the  general  physician.     It  is  of  the  nature  of  a 


80  THE    PRINCIPLES    OP    SCIENTIFIC    MEDICINE. 

truism  to  say  that  no  two  men  are  alike,  and  to  surmount 
this  always  exceedingly  great  obstruction  to  the  laying 
down  of  rules  for  health  guidance,  and  to  give  to  what 
should  be,  what  can  be,  but  general  directions,  the  weight 
of  dogmas,  the  civil  hygienist  (and  the  therapeutist)  rig 
up  the  average  man,  a  subjective  homo,  who,  inasmuch  as 
he  has  no  existence,  demands  no  treatment.  On  the  other 
hand,  the  military  medical  hygienist  views  all  men  as  sol- 
diers; the  efficient  soldier  is  the  standard  by  which  he 
would  measure  all  his  fellow-creatures.  The  penitentiary 
doctor  takes  capacity  for  oakum-picking  and  for  tread- 
mill exercise  as  his  standard,  a  point  of  view  that  is  un- 
impeachable as  long  as  convicts  are  in  question,  but  which 
can  form  the  basis  of  no  guide  to  the  general  health  of 
mankind,  to  whom,  however,  he  can  rarely  resist  the 
temptation  of  applying  it.  The  statistician  tries  to  deduce 
a  moral,  on  insufficient  premises,  as  to  the  danger  attend- 
ant on  many  trades,  but  practically  he  knows  little  if  any- 
thing of  the  main  factors  that  go  to  elevate  the  rate  of 
mortality  in  them.  It  is  much  more  often  the  low  rates 
of  pay,  the  temptations  to  drink,  and  the  drafting  into  oc- 
cupations of  men  who  have  lived  under  totally  different 
conditions,  that  tell  on  the  death-rate,  and  which  are  prac- 
tically all  unpreventable,  rather  than  some  casual  and  pre- 
ventable risk  of  lead,  or  other  metallic,  poison.  The  sole 
condition  of  health  is,  as  Darwin  long  since,  but  in  another 
connection,  expressed  it,  "  correspondence  with  the  envi- 
ronment," in  other  words,  a  power  of  acclimatization,  of 
bodily  adaptation,  to  the  special  surroundings  of  every-day 
life ;  and  for  this  condition  to  be  secured  there  must  exist, 
as  I  have  in  an  earlier  chapter  stated,  three  necessary  con- 
ditions :  a  body  sufficiently'-  ductile,  sufficiently  pla^ic  to 
take,  without  destruction  of  any  vital  part,  the  impressions 
of  the  new  mould  in  which  it  is  to  be  cast,  or  by  which  it 


UNHEALTHY    OCCUPATIONS.  81 

is  already  surrounded,  and  as  a  rule  in  youth  only  is  this 
plasticity  very  great;  secondly,  the  moulding  process  must 
— if  the  new  mould  be  very  different  from  that  in  which 
the  man  is  already  cast — be  always  slow,  and  the  less  plas- 
tic the  body  the  slower  must  be  the  operation;  thirdly, 
the  limits  in  the  process  beyond  which  no  bodily  structure 
can  go,  at  least  in  the  span  of  an  ordinary  lifetime,  must 
be  remembered.  If,  for  example,  you  take  a  middle-aged 
farmer,  and  place  him  in  a  bookbinder's  shop  in  central 
London,  he  will  begin  to  suffer  at  once  from  ill-health, 
and  he  will  probably  continue  so  to  suffer  for  years  ;  his 
body  is,  as  I  explained  when  speaking  of  functional  de- 
rangement, constantly  influenced  by  unusual  forces  in  his 
surroundings,  constantly  oscillating  beyond  the  regular 
limits  of  health,  seeking  ever  to  balance  its  new  conditions 
and  never  succeeding.  "  Ah !"  the  hygienist  will  say,  "  you 
have  placed  him  in  an  imhealthy  employment,  vide  Dr. 
Farr's  tables."  But  what  about  his  fellow- workers,  born 
cockneys?  They  are  thoroughly  well.  Spite  of  their 
white  faces  and  thin  hair,  their  expectation  of  life  is  quite 
up  to  Dr.  Farr's  standard.  Let  us  take  one  of  these  latter, 
a  bookbinder  of  many  years'  standing,  put  him  in  the 
farmer's  old  country  residence,  set  him  to  the  work  of 
farming,  and  visit  him  a  week  or  two  afterwards ;  what 
shall  we  find  ? — that  he  is  brimming  over  with  thankful- 
ness for  an  increase  of  health,  of  spirits,  and  of  bucolic 
virtue  ?  Not  at  all;  he  will  tell  us  that  he  is  not  nearly 
so  well.  The  dullness  and  lack  of  companionship  are,  so 
he  will  tell  us,  killing  him,  and  the  exposure  is  already 
crippling  him  with  rheumatism;  in  fact,  the  bookbinder's 
body  is  experiencing  all  the  throes  which  accompany  an 
atterappt  at  equilibration  with  altered  surroundings,  and 
these  may  last  for  years  or  even  never  cease,  everything, 
as  with  the  transposenj  farmer,  depending  upon  the  adapt- 
4* 


82  THE    PRINCIPLES    OF    SCIENTIFIC    MEDICINE. 

ability  of  the  body  and  the  exact  nature  of  the  environ- 
ment. 

When  we  approach  the  third  condition  to  a  successful 
acclimatization  —  namely,  attention  to  the  limits  within 
which  alone  the  body  of  man  is  plastic,  we  first  see  our  way 
clearly  to  speak  within  very  narrov^  limits  dogmatically  of 
a  few  trades  and  occupations  as  essentially  unhealthy. 
We  know  of  no  process  of  moulding,  however  slow,  which 
can  accustom  the  body  of  man  to  the  absorption  of  much 
lead,  mercury,  antimony,  or  zinc,  nor  of  any  that  can 
make  the  fumes  of  sulphurous  acid  or  of  nitric  acid,  or  an 
air  laden  with  coal-dust,  or  with  fine  particles  of  hair, 
feathers,  etc.,  factors  of  health.  Yet  even  in  the-  trades 
where  workmen  are  exposed  to  such  influences,  the  exer- 
cise of  care  can  minimize  the  danger,  and  a  large  amount 
of  tolerance  of  these  conditions  is  established  in  the  bodies 
of  those  long  exposed  to  their  influences. 

And  what  we  have  said  of  occupations  applies  even 
to  habits.  There  are,  spite  of  the  alarmists,  few  essen- 
tially bad  habits.  If  we  take  such  a  habit  as  smoking 
into  just  consideration,  we  find  ourselves  unable  to  pro- 
nounce a  general  anathema  against  it.  The  anti-tobacco- 
nist will,  indeed,  seek  to  dismiss  the  subject  with  what,  to 
his  mind,  will  seem  a  valid  and  conclusive  reason  against 
the  practice.  "  Smoking  is  clearly  unnatural,"  he  will  tell 
us,  "  and  therefore  ought  to  be  discouraged."  But  when 
we  ask  him  to  define  what  he  understands  by  unnatural, 
we  detect  the  flaw  in  his  argument.  The  fact  of  the  mat- 
ter is,  that  the  word  natural  has,  except  in  wide  limits, 
no  fixed  and  constant  value  whatever  as  applied  to  man  ; 
that  only  can  be  condemned  as  universally  unnatural 
which,  as  far  as  human  experience  goes,  Nature  will  toler- 
ate in  no  individual,  that  which  is  inconsistent,  in  every 
known  instance,  with  health.     We  know  that  an  habitual 


BAD    HABITS,   THEIR    INFLUENCE    ON    MAN.  83 

consiim2)tion  of  mercury,  of  lead,  of  copper,  of  iron,  and 
of  many  other  substances,  renders,  as  far  as  human  expe- 
rience teaches,  the  maintenance  of  the  steady  balance  of 
health  impossible,  but  this  cannot,  by  an  impartial  judge, 
be  affirmed  of  the  systematic  iise  of  tobacco.  That  many 
persist  in  the  habit  of  smoking,  notwithstanding  the  evi- 
dent fact  that  it  is  injurious  to  them,  no  one  can  doubt; 
but  this  may  be  said  equally  of  all  habits,  even  of  the 
simplest  and  of  those  most  generally  commended.  And 
what  is  true  of  smoking  applies  equally  to  the  habit  of 
taking  alcohol.  It  is  only  when  a  certain  limit — varying 
in  each  individual — is  exceeded,  that  the  practice  becomes 
injurious  and  will  deserve  our  condemnation,  while,  up  to 
that  point,  tobacco  or  alcohol  may  become,  may  be,  an 
actual  factor  in  the  maintenance  of  health,  a  factor  which, 
if  the  body  be  aged  or  deranged,  and  therefore  slow  at 
equilibration,  cannot  be  suddenly  dismissed,  under  the 
penalty  of  more  or  less  severe  derangement  of  health.  I 
may  even  proceed  still  further  and  state  that  which  will 
be  borne  out  by  all  medical  men  of  experience  in  the  line, 
that  loss  of  general  health,  evidenced  by  digestive  failure, 
derangement  of  the  heart's  action,  muscular  weakness, 
and,  above  all,  by  prostration  of  the  nervous  system,  is 
the  consequence  of  the  sudden  discontinuance  of  habits 
and  modes  of  life  which  are  distinctly  contra  honos  mores, 
and,  for  the  latter  reason,  and  that  only,  intolerable,  and 
to  be  discontinued  even  were  life  itself  to  be  the  sacrifice. 

The  question  of  clothing,  w^hich  belongs  to  the  dej^art- 
ment  of  habits  and  mode  of  life,  I  shall  deal  with,  practi- 
cally, in  the  second  part  of  this  book. 

A  few  words  b}''  way  of  conclusion.  Our  first  duty  in 
undertaking  any  treatment  is  to  comprehend  the  signifi- 
cance of  the  phenomena  of  disorder,  and  then  to  study 
the  environment — to  be  found  in  the  conditions  of  life — 


84  THE    PRINCIPLES    OP    SCIENTIFIC    MEDICINE. 

of  the  sufferer,  for  this  environment  is  the  mould  in  which 
the  man  is  cast,  and  which  lends  itself  readily  to  such 
alterations  as  may  be  required  for  the  good  of  the  invalid. 
The  process  is  simple,  but  requires  some  thought,  some 
judgment,  often  some  strategy  and  skill.  In  the  first  place, 
the  past  physical  history,  family  and  personal,  has  to  be 
learned.  This  supplies  us  with  data  for  the  estimation  of 
the  original  form  of  the  mould  from  which  the  individual 
has  issued,  that  in  which  he  was  well,  and  to  a  return  to 
which  it  will,  in  most  cases,  be  comparatively  easy,  and 
nearly  always  beneficial,  as  nearly  as  possible  to  revert. 
Inquiries  into  the  medical  history  also  bring  out  the  exist- 
ence of  certain  constitutional  taints — gout,  insanity,  etc. — 
of  which  otherwise  we  should  possibly  have  remained  com- 
pletely ignorant,  and  which,  in  a  latent  state,  may  be  at 
the  bottom  of  much  mischief.  Then  the  plasticity  of  the 
body  of  the  patient  has  to  be  gauged.  This  will  depend 
on  his  age,  on  the  presence  of  structural  disease,  on  the 
rate  at  which  he  has  been  spending  life,  for  there  is  sound 
philosophy  in  the  French  adage,  "L'homme  a  toujours 
I'age  de  son  cceur,"  which  teaches  us  that  a  man  may  be 
gray  at  heart  when  few  summers  have  passed  over  his 
head,  or,  conversely,  be  old  in  years  and  young  in  strength 
and  vital  energy. 

Having  thus  arrived  at  as  correct  an  estimate  as  is  pos- 
sible, in  the  circumstances  of  any  given  case,  of  the  sum 
and  the  distribution  of  the  forces  of  the  invalid's  body, 
and  having  considered  the  various  agencies  which  have 
brought  about  the  present  physical  derangement  and  the 
part  played  by  each  one  of  them  in  the  process,  we  turn  to 
the  three  great  measures  which  I  have  discussed  for  means 
of  relief.  All  of  them  will  often  require  to  be  pressed  into 
our  service.  This  caution  is  necessary,  for  even  the  fair 
and  open  field  of  hygiene,  that  in  which  it  might  have  been 


FALLACIOUS    VIEWS    OF    DISEASE.  85 

imagined  no  guide  but  common-sense  would  have  been  tol- 
erated, is  infested  with  those  pseudo-pilots  of  medicine — 
the  one-idea  men.  These  "worshippers  of  detached  ideas," 
as  Professor  Bonamy  Price  would  have  called  them,  stum- 
bling against  a  fragment  of  truth,  would  have  us  to  cling 
to  it  alone  for  physical  salvation,  to  the  ignoring  of  all 
else.  Such  are  the  men  who  are  going  to  regenerate  hu- 
manity by  means  of  diet  only,  or  of  climate,  or  of  elec- 
tricity, or  of  massage,  or  of  faith  in  hysterical  religion. 
They  are  conscious  that  there  is  truth  in  their  means  of 
cure,  but  they  fail  to  see  its  limit.  They  are  ignorant  of, 
or  they  shut  their  eyes  to,  the  one  great  physical  truth, 
that  the  body  of  man  is  the  equation  of  all  his  surround- 
ings. Not  on  one  power  alone  in  these  surroundings,  to 
the  exclusion  of  all  others,  can  reliance  alone  be  placed, 
but  on  a  wise  and  skilful  combination  of  all  of  them. 
Again,  the  various  theorists  of  this  order  are  not  even 
agreed  among  themselves  as  to  the  ideal  man  ;  the  one 
recognizing  great  capacity  for  mental  work  as  the  stand- 
ard of  perfection,  another  the  virtues  which  go  to  form 
the  athlete,  another  those  which  mark  the  moral  and  relig- 
ious man. 

I  have  now  completed  my  very  short  sketch  of  the  three 
great  every-day  moulders  of  mankind — diet,  climate,  and 
habit.  It  is  evident,  provided  the  exact  nature  and  the 
extent  of  any  malady  be  determined,  and  the  body  of  the 
invalid  be  not  already  partially  destroyed  by  structural 
disease,  that  these  great  agents,  wisely  moderated  to  suit 
the  exigencies  of  each  case,  will  be  equal  to  its  relief  and 
cure.  In  the  darkest  ages  of  superstition  this  fact  has 
always  been  recognized  by  a  chosen  few,  and  at  the  pres- 
ent day,  though  rarely  acted  up  to,  is  never  seriously  con- 
tested. Why,  then,  is  recourse  had  so  often  to  the  extraor- 
dinary  measures,   drug   action,  powerful   and   unnatural 


86  THE    PRINCIPLES    OF    SCIENTIFIC    MEDICINE. 

mental  influences,  etc.  ?  Mainly  for  two  reasons  :  the  first 
being  that  the  means  of  cure  by  ordinary  measures  are 
often  out  of  reach  of  the  sick  man  or  not  according  to 
his  inclination  ;  and  the  second,  that  there  is  even  now  a 
considerable  hesitation,  even  in  high  scientific  quarters,  in 
throwing  over  the  old  belief  in  the  supernatural  causation 
of  disease,  and  a  belief  in  this  is  inconsistent  with  an  hon- 
est reliance  on  the  every-day,  common-sense  methods  of 
cure. 

Certainly  nine  tenths  of  the  sick  people  one  is  called  on 
to  treat  think  they  discern  in  their  disease  the  hand  of  the 
Almighty  scourging  them  for  some  moral  defect,  and  not, 
as  it  should  be,  and  is,  his  hand  leading  them,  by  the 
operation  of  natural  laws,  back  from  physical  transgres- 
sions and  their  certain  consequences,  to  the  enjoyment  of 
health.  Only  when  it  has  come  to  be  recognized,  and  the 
main  object  of  this  book  is  to  teach  it,  that  the  latter  is 
the  real  solution  of  the  problem  of  disease,  will  natural 
remedies  receive  their  full  share  of  popular  reliance ;  and 
even  then  extraordinary  measures,  such  as  drugs,  though 
occupying  a  subordinate  position,  will  not  be  completely 
discarded,  for  they,  as  I  shall  attempt  to  show  in  the  next 
chapter,  find  a  place,  by  no  means  unimportant,  in  a  sclieme 
of  scientific  and  rational  medicine. 


CHAPTER  V. 

THE   PRINCIPLES   OF    SCIENTIFIC   MEDICINE 

{continued). 

TREATMENT   BY  EXTEAORDESrARY  MEASURES. 

Extraordinary  measures  are  called  for  in  treatment,  because  extraor- 
dinary combinations  of  forces  are  relied  on  in  health  by  civ- 
ilized man.  Medicines  may  act  in  any  one  of  the  following 
ways :  {a)  as  foods  ;  {U)  as  elements  of  disturbance,  of  which 
nature  are  stimulants,  tonics,  and  alteratives  ;  (c)  as  mechanical 
scavengers  ;  or  {d)  as  antidotes.  An  instance  of  the  treatment 
in  a  case  of  gout.  The  fallacies  of  the  orthodox  drug  system : 
(«)  its  assumption  of  the  possibility  of  local  disease  ;  {b)  its  pre- 
tence to  possess  drugs  that  act  only  locally  ;  (c)  its  wrong  in- 
ductions ;  {d)  its  misinterpretation  of  the  phenomena  of  disease, 
and  consequent  misapplication  of  remedies.  The  only  rational 
lines  of  treatment.  Physico-mental  agents.  Structure  of  the 
nervous  system  and  method  in  which  it,  and,  through  it,  the 
whole  body,  is  affected  by  these  agents. 


CHAPTER  Y. 

THE  PRINCIPLES  OF  SCIENTIFIC   MEDICINE 

{continued). 

TREATMENT  BY  EXTRAORDINARY  MEASURES. 

"The  day  of  orthodoxies  is  over;  the  day  of  real  science  is  only  just 
dawning.  Enormous  evils  have  accrued  to  humanity  and  to  tlie  medical 
art  from  a  blind  reliance  upon  the  traditions  of  the  ag-es,  and  often  upon 
traditions  wrongly  interpreted.  .  .  .  The  physician  of  the  future  will  do 
well  if  he  remembers  always  the  pernicious  despotism  which  has  been  ex- 
ercised over  his  own  art  by  the  fetters  of  these  dead  orthodoxies,  and  will 
therefore  be  very  slow  to  acknowledge  their  claim  upon  him  to  any  more 
than  an  historical  regard." — Professor  Gairdner  {Presidential  Address  on 
Medicine  at  the  British  Medical  Association's  Annual  Meeting  in  August^  1888). 

"  La  mddecine  aurait  done  besoin  d'etre  soumise  a  une  critique  analogue 
a  celle  que  Kant  a  fait  subir  a  la  philosophic.  Par  cette  operation  cruelle 
sans  doute,  mais  en  definitive  salutaire,  elleperdrait  beaucoup  de  ses  pre- 
tensions ambitieuses  et  de  ses  droits  usur^Des,  mais  elle  verrait  clair  dans 
ses  affaires  et  pourrait  vivre  avec  securite  et  honneur." — Louis  Peisse. 

"  True  science  is  perennial ;  systems  of  science  are  perishable.  Science 
belongs  to  mankind ;  a  system  only  to  the  time  and  circumstances  which 
have  begotten  it." — Hufeland. 

TowAKDS  the  conclusion  of  the  last  chapter  I  hinted 
that  in  the  actual  conditions  of  every-day  civilized  life, 
circumstances  may  and  do  constantly  arise  which  warrant 
a  recourse  to  various  forces  of  Nature,  differing  often  so 
far  both  in  intensity  and  in  character  from  those  to  whose 
influence  mankind  is  commonly  subject,  as  to  deserve  the 
title,  when  applied  to  man  in  his  physical  distresses,  of  ex- 
traordinary measures  of  treatment. 

But  why  should  man,  born  of,  and  ever  environed  by, 


90  THE    PRINCIPLES    OP    SCIENTIFIC    MEDICINE. 

tlie  ordinary  forces  of  Nature,  seek  aid  from  combinations 
of  force  apparently  foreign  to  his  economy  ?  Such,  in  con- 
densed form  is  the  plausible  argument  of  a  school  ycleped 
hygienic,  that  professes  to  worship  Nature  without  ap- 
parently having  any  adequate  comprehension  of  her  ways. 
Man  is  not  a  constant  quantity — and  this  truism  cannot 
be  too  often  reiterated — but  each  individual  of  the  race, 
while  preserving  a  general  common  likeness  to  all  its  other 
members,  is  compounded  of  forces  infinitely  diverse  both 
in  arrangement  and  in  relative  amount.  We  allow  our- 
selves to  be  deceived  by  a23pearances,  and  because  the 
North  American  Indian  and  the  Englishman  agree  in  their 
number  of  limbs,  in  their  mode  of  progression,  and  in  the 
possession  of  certain  special  senses,  we  call  each  a  man,  and 
then  unconsciously  assume  them  to  be  practically  in  all 
respects  equal  in  their  physical  attributes.  It  is  only  when 
we  surround  the  noble  savage  with  what,  to  us,  are  the 
great  blessings  of  civilization,  because  they  have  become 
a  necessary  part  in  our  environment,  and  remark  how  the 
darker  race  pines  and  dies,  that  we  begin  to  comprehend 
that  these  men,  so  similar  to  us  in  the  contour  of  their 
bodily  structure,  demand,  for  continued  health  and  vigor, 
surroundings  in  life  widely  different  from  our  own.  The 
savage,  accustomed  to  face  and  to  battle  with  untamed  Nat- 
ure, languishes  in  civilization  just  as  do  flowers  and  shrubs 
rudely  translated  to  new  soils  and  fresh  climates.  Physi- 
ology knows  no  rigid  ideal ;  that  only  is  best  for  the  health 
of  the  individual  which  his  body  is  best  fitted  to  balance  ; 
each  body  has  been  produced,  and  is  maintained  in  health, 
by  a  separate  mould,  and  the  shape  of  that  mould  cannot 
in  any  direction  be  suddenly  altered  without  throwing  the 
whole  contents,  temporarily  or  permanently,  out  of  bal- 
ance. Health,  then,  is  an  equilibrium  with  special  sur- 
roundings, varying  in  the  case  of  every  man,  not,  as  the 


METHODS    TX    WHICH    MEDICINES    ACT.  91 

liygienist  would  liave  us  believe,  conformity  with  some 
ideal  environment.  The  European  of  the  nineteenth  cen- 
tury has  long  since  ceased  to  be  a  child  of  Nature  ;  for 
the  maintenance  of  health  he  demands  what,  from  the 
point  of  view  of  the  savage,  are  extraordinary  conditions, 
and  for  the  relief  of  physical  suffering  he  may,  therefore, 
for  very  sound  reasons,  look  also  for  extraordinary  rem- 
edies. That  the  latter  have  become  discredited  is  due  only 
to  their  misapplication,  and  to  a  misinterpretation  of  the 
phenomena  of  Xature  as  observed  in  disease. 

All  extraordinary  measures  of  treatment  may,  for  the 
sake  of  convenience,  be  divided  into  medicinal  and  phy- 
sico-mental.  This  division  is  purely  an  artificial  one,  for 
the  only  essential  difference  between  the  two  varieties  lies 
in  the  channels  through  which  they  act  on  the  body,  the 
medicinal  selecting  generally  the  blood  system,  the  phy- 
sico-mental  the  nervous  system  exclusively. 

The  methods  in  which  medicines  act  may  thus  be  sum- 
marized : 

The  human  body  consists,  as  we  know,  of  cells  which 
receive  and  store  the  energies  derived  from  food,  which 
food,  in  the  form  of  blood,  is  ever  circulating  in  our  tis- 
sues. The  cells  of  the  separate  organs,  moulded  variously 
by  the  conditions  which  surrounded  their  growth,  differ, 
for  reasons  already  fully  explained  in  our  first  chapter, 
not  only  in  external  outline,  but,  by  virtue  of  that  colloid- 
al character  which  permits  of  their  interior  being  per- 
meated and  "moulded  by  crystalloid  material  in  solution, 
also  in  actual  chemical  composition,  and  being  thus  en- 
dowed with  different  chemical  afiinities,  they  abstract  from 
the  blood-current  different  materials  and  hence  perform 
different  functions.  If,  therefore,  you  introduce  into  the 
blood-current  soluble  crystalloids,  such  as  are  the  vast  ma- 
jority of  our  drugs,  it  is  clear  that  not  only  ^^'ill  they  act 


92  THE    PRINCIPLES    OF    SCIENTIFIC    MEDICINE. 

upon  each  and  every  cell,  but  that  they  will  act  in  a  very 
unequal  manner  on  the  various  groups  of  cells,  the  so- 
called  organs. 

We  will  now  briefly  discuss  the  drug  system,  and  seek 
from  the  tangled  mass  of  medical  creeds  to  arrive  at  some- 
thing like  a  correct  conclusion  as  to  the  limits  within  which 
the  employment  of  medicinal  agents  is  commendable. 

Medicines. 

Medicines,  when  taken  internally,  act,  then,  in  almost 
every  case  by  way  of  the  blood-channels,  and,  mixing  with 
the  blood-stream,  are  conveyed  with  the  food  to  every  por- 
tion of  the  body. 

Kow  we  know  that  the  cells  of  the  different  organs  of 
the  body  differ  in  chemical  composition  (^.  e.,  in  the  ar- 
rangement of  their  constituent  molecules),  and,  according 
to  the  chemical  afiinities  existing  between  them  and  the 
foods  presented  to  them,  so  do  they  act  more  or  less  accord- 
ing to  chemical  laws  on  that  food.  Precisely  the  same 
occurs  in  the  case  of  medicines. 

By  the  light  of  these  simple  facts  let  us  see  in  bow  many 
ways  medicines  can  act  on  the  cells. 

1.  As  Foods. — We  possess  no  known  medicinal  com- 
pound which  can  merit  the  name  of  a  real  tissue-food  or 
in  any  way  replace  albumen. 

It  is  true  that,  in  caffeine  and  guaranine,  we  have  com- 
plex nitrogenous  bodies  which  exert  a  marked  influence 
on  the  body,  and  that  phosphorus — an  element  having  in 
its  chemical  attributes  some  relationship  to  nitrogen — has 
been  vaunted  as  a  nerve-food,  but  these  drugs,  and  others 
of  the  same  class,  cannot  be  administered,  for  any  extended 
period,  without  producing  obvious  mischief,  and  therefore 
cannot  actually  be  classed  as  substitutes  for,  or  even  as 
real  adjuncts  to,  our  natural  tissue-food,  albumen. 


FOOD-MEDICLNES.  93 

Popularly  classed  as  medicines  we  possess,  however, 
some  very  useful  fuel-foods.  Cod-liver  oil  and  the  vari- 
ous fatty  emulsions  are  of  this  nature,  to  which  also  be- 
long the  so-called  malt  extracts.  Many  of  the  lighter 
wines  and  the  malt  liquors  may  also  find  a  place  under 
this  heading,  though  their  action  on  the  body  is,  unlike 
that  of  the  pseudo-drugs  just  named,  not  purely  nutritive. 
Necessary  salts  that  have  been  omitted  from  every-day 
food  are  sometimes  administered  as  drugs  and  spoken  of 
as  substances  alien  to  the  body,  though  they  cannot  really 
be  viewed  in  that  light. 

Thus  many  salts  of  sodium,  potassium,  ammonium,  mag- 
nesium, lime,  and  iron  are  natural  constituents  of  the  hu- 
man frame,  and  the  necessary  amount  of  each  is  repre- 
sented, though  we  may  be  unconscious  of  the  fact,  in  our 
common  articles  of  diet.  Sometimes,  however,  especially 
among  the  rich,  who  prefer  the  finer  varieties  of  meal, 
which  contain  too  small  a  percentage  of  these  salts,  it  be- 
comes very  necessary  to  order  by  themselves,  and  in  the 
form  of  medicine,  these  preparations.  Great  good  may 
thus  be  effected,  but  the  dose  of  the  salt  must  never  be 
too  large  in  amount,  and  it  must  be  administered  in  a 
great  deal  of  water.  This  is  the  secret  of  the  great  suc- 
cess in  gouty  states  of  such  very  weak  mineral  waters  as 
those  of  Contrexeville  and  Kronenquelle,  and  of  many 
others,  and  of  the  evil  wrought  by  large,  concentrated 
amounts  of  the  same  salts  when  obtained  by  prescription. 

Under  this  heading  of  foods,  we  may  also  rank  certain 
artificial  digesters  of  food,  of  which  pepsin,  trypsin,  pan- 
creatin,  and  malt  are  familiar  examples.  Their  field  of 
utility  is  very  restricted.  When  of  the  best  manufacture, 
and  administered  with  correct  knowledg^e  of  the  condi- 
tions  under  which  alone  it  is  possible  for  them  to  act  in  a 
desirable  way,  they  digest  artificially  certain  foods,  but  this 


94  THE    PEINCIPLES    OF    SCIENTIFIC    MEDICINE. 

only  franks  these  foods  through  the  wall  of  the  stomach 
or  intestme  ;  it  can  do  no  more,  and,  as  physiology  tells  us, 
this  is  but  a  fraction  of  complete  digestion.  It  is,  more- 
over, demonstrable  that  they  can  only  do  this  when  the 
general  bodily  health  is  fairly  good,  a  state  of  matters  in 
which  they  can  rarely  be  required.  In  the  presence  of 
any  marked  gastric  or  intestinal  derangement,  such  as  is 
present  in  febrile  states,  they  are  ofttimes  administered 
by  the  ignorant  with  a  view  to  circumvent  the  beneficial 
blockade  w^hich  Nature  has  established  at  those  many 
mouths  of  supply  of  the  circulation  situate  in  the  stomach 
and  bowel,  but,  fortunately  for  the  patient,  such  attempts 
usually  fail. 

II.  As  Elements  of  Disturbance,  in  respect  to  the  ordi- 
nary cell  functions.  Most  of  this  class  act  as  stimulants, 
their  eifect  being  more  marked  on  some  tissues  than  on 
others.  Alcohol,  chloroform,  ether,  opium,  Indian  hemp, 
etc.,  are  examples  of  such  acting  in  various  ways,  but 
always  mainly  as  stimulants,  on  the  nervous  tissue,  their 
stimulating  action  on  the  cells  being,  more  or  less,  speedily 
followed  in  every  case  by  a  species  of  arrest  of  function. 
We  do  not  wonder  at  this  result  when  we  remember  that 
a  stimulant  does  not,  cannot,  generate  energy,  but  can  only 
liberate  that  already  stored  in  the  cells.  It  can,  therefore, 
only  leave  behind  a  state  of  cell  exhaustion.  Each  of  the 
above  stimulants  selects  by  preference — really  by  chemical 
affinity — a  certain  portion  of  the  nervous  system,  but  they 
do  not,  as  w^e  know,  leave  the  other  portions  of  this  sys- 
tem or  of  the  general  body  unaffected,  though  these  col- 
lateral effects  are  often  masked  by  the  more  striking  ner- 
vous ones.  Then  we  have  the  large  group  of  so-called 
alteratives,  under  which  heading  the  orthodox  therajieu- 
tist  ranks  any  drug  that  will  disturb  the  economy,  and 
recommends  it  to  be  administered  in  obscure  diseases  on 


THE    SO-CALLED    ALTERATIVE    AND    TONIC    DRUGS.        95 

the  off-chance  that  a  better  condition  of  health  may,  after 
a  general  concussion,  make  its  a23pearance.  Then  comes  a 
large  grouj)  of  slow  stimulants,  which,  according  as  they  act 
most  conspicuously  on  any  one  part  of  the  body,  are  said  to 
tone  that  part,  and  are  called  tonics.  There  is  absolutely  no 
place  in  the  economy  of  man's  body  for  a  drug,  unless  it  be  a 
food  that  acts  as  a  permanent  restorer  of  health  and  tone, 
for  practically  that  is  what  the  therapeutist  wishes  to  be 
understood  by  the  word  tonic.  Iron  is  either  a  food  or  a 
poison  according  as  it  is  administered,  quinine  is  probably 
a  food,*  while  many  wines  and  malted  liquors,  phosphorus, 
caffeine,  etc.,  are,  in  varying  proportions,  foods  as  well  as 
stimulants.  Digitalis,  strophanthus,  nux  vomica,  strych- 
nia, and  vegetable  bitters  are,  in  their  ordinary  dosage, 
examples  of  slow  stimulants,  and  their  use  is  attended  by 
that  fatal  but  inevitable  drawback  attendant  on  such 
stimulation — viz.,  subsequent  exhaustion,  which  manifests 
itself  most,  but  7iot  solely,  in  the  organ,  the  cells  of  which 
have  shown  the  greatest  affinity  for  the  drug.  It  is  true 
that  the  unfortunate  patient  will  but  rarely  attribute  his 
eventual  breakdown  to  the  drug-stimulant  upon  which  he 
has  been  relying  for  help,  for  he  is  quite  ignorant  of  what 
the  course  of  his  malady  would  otherwise  have  been,  and 
he  is,  therefore, not  in  a  position  to  trace  cause  and  effect; 
but  any  skilled  physiologist  will  assure  him,  with  me,  that 
a  tonic  is  a  mere  therapeutist's  day-dream,  a  scientific  ab- 
surdity, and  any  intelligent  man  who  has  had  experience 
of  both  the  orthodox  and  the  expectant  systems  of  treat- 
ment can  also  assure  him  that  recovery  without  the  use  of 

*  An  alkaloid  resembling,  if  not  identical  with,  quinine,  exists, 
according  to  Drs.  Dupre  and  Bence-Jones,  normally  in  the  liver 
and  other  animal  organs,  and,  according  to  Dr.  Lauder  Brunton, 
near  allies  of  it  are  found,  in  considerable  quantity,  in  the  human 
intestine. 


96  THE    PEINCIPLES    OF    SCIENTIFIC    MEDICINE. 

tonics  is  more  prompt,  and,  above  all,  more  lasting,  than 
that  apparently  favored  by  the  use  of  these  agents. 

I  have  said  that  there  are  some  members  of  this  group 
which,  from  their  extensive  range  and  their  rapidity  of 
action,  may  be  called  general  stimulants,  while  there  are 
others  which  show  a  preference,  a  chemical  affinity,  for 
some  one  or  more  organs  only,  and  act  much  more  slowly. 
There  exists  yet  a  third  variety,  whose  action  is  such  that 
one  of  the  several  functions  of  the  cells  in  an  organ  only 
is  stimulated,  while  the  others  are  more  or  less  unaltered. 
Take  an  example.  The  liver  cells  have  each  three  or  four 
important  and  very  different  duties  to  perform,  yet  we 
possess  drugs  that  can  increase  temporarily  their  power  of 
bile-making,  while  leaving  their  other  functions  in  statu 
quo.  The  members  of  this  last  subdivision  of  stimulants 
are  numerous  and  important,  but  are  perhaps  greater  dis- 
turbers of  the  general  economy  than  any  others,  and  re- 
quire to  be  therefore  used  with  the  greatest  wisdom  and 
discretion. 

III.  The  third  Group.,  ichlch  act  as  3Iechanical  Scaven- 
gerSy  is  a  small  one,  and  it  must  be  confessed  that  nearly 
all  its  members  belong  more  or  less  to  the  class  just  named, 
that  of  local  stimulants.  Castor  oil  is  the  best  example  of 
a  drug  whose  action  is  almost  purely  that  of  an  evacuant 
acting  on  the  intestine,  and  water  consumed  in  such  large 
quantities  as  to  merit  the  name  of  an  extraordinary  remedy, 
perhaps  our  only  example  of  one  that  acts  on  the  urinary 
and  cutaneous  system  in  a  like  simple  manner. 

IV.  The  fourth  Group  coiisists  of  certain  Antidotes  to 
Poiso7is. — But  what  is  a  poison  ?  It  is  that  quantity  of 
anything,  be  it  popularly  viewed  as  food  or  drug,  which 
will  act  deletcriously  on  the  human  body.  Thus  common 
salt  and  the  most  prized  of  our  fruits  may,  when  consumed 
in  excess  of  our  needs,  act  as  violent,  or  even  as  fatal,  poi- 


A    SPECIMEN    OF    EATIONAL    TEEATMEXT.  97 

sons.  Under  the  beading  of  antidotes  to  poison  may  also 
be  classed  all  drugs  which  destroy  parasites,  as  also  all 
chemical  compounds  which  directly  neutralize  the  effects 
of  such  dangerous  compounds  as  arsenious  acid,  strong 
alkalies,  acids,  etc.  It  is  much  to  be  regretted  that  we 
possess  not  one  single  drug  that  has  the  power,  without 
killing  the  patient,  of  destroying  the  fever  ferment  which 
has  entered  the  blood-stream.  Perhaps  this  is  not  to  be 
wondered  at,  since  we  are  not  as  yet  quite  certain  as  to  the 
identity  of  the  special  poison  in  each  case.  Quinine  was 
long  thought  to  be  such  an  antidote,  but  its  title  to  such  a 
claim  is,  for  reasons  already  given,  open  to  serious  doubt. 

Such  beino;  the  divisions  within  which  all  medicines  that 
can  produce  any  effect  whatever  on  the  body  of  man  are 
susceptible  of  being  ranged,  I  will  now  very  briefly  sketch 
the  plan  upon  which  they  should  be  administered,  and 
will  then  show  to  what  depths  of  absurdity  partial  ex- 
periments, a  blind  reliance  on  tradition,  prejudice,  and  in- 
famous logic  have  sunk  the  orthodox  therapeutist  lights 
of  the  present  day. 

Let  us  hark  back  for  a  moment  and  ima2:ine  ourselves 
in  the  presence  of  an  invalid  suffering  from  a  mild  attack 
of  gout.  AYe  will  also,  for  the  sake  of  simplicity,  suppose 
that  all  the  organs  of  his  body  are,  for  his  time  of  life, 
structurally  perfect.  ^ 

In  gout  we  have  in  the  first  place,  as  prime  cause,  a 
liver  that,  as  the  result  of  overwork,  of  congenital  weak- 
ness, of  debility  in  its  nerve  supply,  or  most  often  of  all  of 
such  causes  combined,  has  broken  down  in  one  of  its  main 
functions,  the  making  of  urea.  As  a  direct  result  of  this 
breakdown,  uric  acid,  a  less  oxidized  substance  than  urea, 
a  kind  of  half -formed  urea,  appears  in  large  quantities  in 
the  blood. 

Like  the  urea  which  it  in  part  rejilaces,  uric  acid  must 
5 


98  THE    PRINCIPLES    OF    SCIENTIFIC    MEDICINE. 

pass  out  of  the  body  by  the  kidneys.  If  these  organs  are 
in  good  condition,  they  strain  it  off  rapidly,  and  if  present 
in  large  quantities,  it  will  appear  in  the  urine  as  sand  or 
gravel.  If  the  patient  continues  his  usual  course  of  life, 
and  the  kidneys  remain  functionally  active,  this  sand  will, 
at  short  intervals,  for  a  long  period  of  years,  make  its  ap- 
pearance, though  there  is  ever  present  the  grave  risk  that 
some  of  it  may  be  retained  in  the  kidney  or  bladder  and 
form  the  nucleus  of  a  hard  stone. 

In  the  vast  majority  of  cases,  however,  the  excretion  of 
uric  acid  does  not  keep  pace  with  its  production,  and  as  a 
result  the  uric  acid  accumulates  in  the  blood.  Now  com- 
mences to  be  manifested  a  host  of  symptoms — all  of  them 
endeavors  by  the  body  to  cast  out  the  offender — two  or 
three  of  the  commonest  of  which  we  will  refer  to.  The 
surface  of  the  stomach  inflames,  in  other  w^ords,  gastric 
catarrh  sets  in ;  the  patient's  appetite,  and  indeed  his  pow- 
er of  retaining  food,  are  both  arrested,  the  supplies  of 
nitrogenous  food,  from  which  uric  acid  is  formed,  are  cut 
off,  and  the  kidneys  are  thus  afforded  time  to  deal  with 
the  poison  whose  production  has  hitherto  exceeded  their 
powers  of  elimination.  More  than  this,  however,  occurs: 
the  heat  of  the  inflammatory  action  going  on  in  the  stom- 
ach wall  helps  to  convert  the  uric  acid  in  the  blood  to 
urea,  and  this  process  is  further  favored  by  the  oxygen  in 
the  l)lood,  which,  finding  an  insufliiciency  of  fuel-food, 
readily  assists  in  the  oxidation  of  the  uric  acid,  wiiich, 
oxidized,  becomes  urea. 

As  there  is  no  difficulty  in  the  excretion  even  of  large 
quantities  of  urea  by  the  kidneys,  it  thus  happens  that 
in  two  or  three  days  the  excess  of  uric  acid  which  has  set 
up  the  symptoms  will  be  expelled  the  blood-current,  and 
health  will  return. 

Instead  of  the  stomach  one  or  more  joints  may  become 


A    SPECIMEN    OF    RATIONAL    TREATMENT.  99 

inflamed.  The  sequence  of  matters  is,  however,  still  the 
same,  the  loss  of  appetite  and  the  inflammation  leading  di- 
rectly to  a  cure.  In  other  cases,  in  place  of  either  the 
stomach  or  a  joint,  the  external  skin  will  take  on  the  in- 
flammatory action,  and  patches,  more  or  less  extensive,  of 
acute  eczema  will  be  seen.  The  chain  gives  way  at  its 
weakest  link,  and  the  least  healthy,  or  most  overworked 
and  exhausted,  organ  of  the  body  will  be  the  first  to  hang 
out  the  signal  of  distress ;  but  the  process  of  cure  thereby 
induced  is  in  all  cases  the  same. 

It  is  scarcely  necessary  to  indicate  the  lines  of  treat- 
ment, so  obvious  must  they  be. 

{a)  We  cut  down  at  once  the  supply  of  albumen,  the 
nitrogenous  food  from  which  comes  uric  acid,  to  the  least 
possible  dimensions,  and  we  further  advise  the  patient  to 
be  always  in  the  future  exceedingly  cautious  not  to  con- 
sume, in  any  but  the  least  quantities  compatible  with 
health,  this  form  of  food,  and  we  do  wisely  to  add  the 
caution  that  all  combinations  of  food  which  usually  cause 
distress  to  a  weak  stomach  will  deleteriously  tell  on  the 
gout.  We  furthermore  give  a  smart  purge  to  stop  at 
once  the  further  passage  of  supplies  of  albumen  to  the 
liver  by  emptying  the  stomach  and  bowels.  Lastly,  we 
order  an  alkaline  salt,  as  uric  acid  robs  the  blood  of  alka- 
lies by  forming  compounds  with  them. 

(b)  We  try  to  wash  out  the  surplus  uric  acid  by  giving 
large  draughts  of  water,  and  we  may  administer  some 
drug  that  excites  the  kidney,  already  excited  by  the  pres- 
ence of  the  excess  of  uric  acid,  to  further  action. 

(c)  We  enjoin  rest  to  the  inflamed  organs,  and  we  in- 
crease the  amount  of  heat  already  present  in  them  by  the 
application  of  poultices,  or  we  prevent  the  radiation  of 
heat  from  them  by  means  of  cotton-wool  or  flannel. 

(d)  Sometimes,  so  acute  is  the  pain,  we  are  forced  to 


100  THE    PKINCIPLES    OF    SCIENTIFIC    MEDICINE. 

cut  short  the  attack  by  a  few  doses  of  a  potent  and  special 
liver  stimulant,  colchicum.  This  practice  is,  however,  as 
all  gouty  men  know,  not  a  commendable  one,  for  the  pres- 
ent benefit  is  purchased  at  the  certainty  of  a  return  of  the 
attack  more  speedily  than  would  otherwise  have  been  the 
case. 

Such,  with  a  few  general  hints  as  to  the  avoidance  of 
worry,  and  a  possible  change  of  climate,  together  with  a 
short  inquiry  into  the  patient's  habits  and  mode  of  life  to 
ascertain  if  in  them  is  to  be  found  any  cause  directly  pro- 
vocative of  gout,  complete  our  indications. 

We  have  thus  in  the  one  complaint  presented  to  our  view 
the  great  truths  that  underlie  the  scientific  and  rational 
use  of  drugs. 

We  administer  a  needed  food,  an  alkaline  salt,  while 
we  suppress  the  further  supply  of  unnecessary  ones.  We 
use,  in  the  form  of  a  purgative  and  of  water,  useful  scav- 
engers. We  favor  the  symptoms  of  disease,  as  far  as  is 
2)0ssible,hj  means  of  drugs.  We  do  not  try  an  antidote, 
because  we  do  not  possess  one,  and  if,  in  a  weak  moment, 
w^e  have  recourse  to  a  stimulant  (colchicum),  we  regard  it, 
with  wisdom,  as  only  a  doubtful  friend. 

From  this  example  we  learn  that  people  who  live  under 
the  extraordinary  conditions  of  civilization,  in  an  environ- 
ment which  is  not  that  of  man  in  a  state  of  nature,  are 
justified  by  their  own  reason  in  having  recourse  to  certain 
extraordinary  agents  in  their  search  for  the  means  of  re- 
covery, more  especially  if  they  have  first  made  a  satis- 
factory trial  of  ordinary  means  and  have  found  these  lat- 
ter unequal  to  the  occasion. 

Do  I  then  consider  that  the  British  Pharmacopoeia  and 
the  various  standard  commentaries  thereon  are  safe  guides, 
and  that,  when  the  Darwin  of  tlie  future  shall  have  regen- 
erated medicine,  these  books  will  still  occupy  an  honored 


THERAPEUTIC    FALLACIES.  101 

place  ?  Not  for  one  moment.  There  is  not  one  of  them 
that  is  not  a  mine  of  fallacious  reasoning,  while  in  the  one 
or  two  that,  discarding  a  mere  dependence  on  written  and 
oral  tradition,  attempt  to  support  their  drug  system  by  an 
appeal  to  experiment,  the  proof  in  every  single  case  com- 
pletely fails  because  of  the  striking  incompleteness  of  the 
experiment.  I  will  briefly  indicate  one  or  two  of  the 
flaws  patent  to  even  the  least  learned  of  the  readers,  and 
which  vitiate  the  conclusions  arrived  at. 

First  of  all,  and  on  every  page  of  such  works,  the  exist- 
ence of  purely  local  disease  is  assumed.  Now,  it  is  scarce- 
ly necessary  to  inform  the  reader  that  if  there  is  one  fact 
in  physiology  which  is  established  beyond  all  doubt,  and 
the  truth  of  which  is  universally  accepted,  it  is  that  all 
the  parts  of  the  body  are  absolutely  and  perfectly  interde- 
pendent. They  are  not,  of  course,  all  of  equal  importance 
to  the  economy,  but  not  one  derangement,  however  insig- 
nificant, is  conceivable  which  does  not  react  on  the  whole 
economy,  or  which  is  not,  as  is  more  frequently  the  case, 
an  expression  of  a  general  disorder  of  the  body.  It  is  true 
that  the  existing  general  derangement  cannot  always  be 
submitted  to  ocular  demonstration.  Medical  men  often 
have  presented  to  them  skin  affections  of  very  limited 
area.  When  the  patient  is  questioned  as  to  his  general 
health,  he  replies  that  he  is  exceptionally  sound  and  well. 
No  physical  examination  may  be  able  to  shake  this  asser- 
tion; the  microscope  may  fail  to  show  in  the  blood  the 
very  faintest  sign  of  disorder,  and  yet  the  skin  disease 
will  often  tell,  more  plainly  than  could  words,  of  a  consti- 
tution rotted  to  its  last  fibre  by  scrofula,  syphilis,  or  other 
constitutional  taint. 

Having  assumed  the  existence  of  strictly  localized  dis- 
ease, the  therapeutist  almost  naturally  passes  on  to  another 
assumption,  equally  at  variance  with  all  scientific  research, 


102  THE    PRINCIPLES    OP   SCIENTIFIC    MEDICINE. 

of  the  existence  of  drugs  whose  action  is  also  purely  local. 
I  have  said  that  drugs,  like  foods,  have  onore  affinity  for 
one  organ  than  for  another,  but  even  if  it  were  possible 
that  any  medicine,  after  in  some  way  modifying  the  con- 
stitution, and,  then  of  necessity,  the  function  of  one  organ, 
could  then  pass  straight  out  of  the  body  without  produc- 
ing the  least  action  in  its  transit  on  any  other  tissue,  even 
in  such  a  practically  impossible  case,  the  changes  set  up  in 
the  aifected  organ  would  react  on  the  whole  body. 

In  all  fairness  it  must  be  admitted  that  the  therapeutist 
will  state — as  far  as  medical  knowledge  goes  in  this  mat- 
ter, which  in  the  case  of  no  single  drug  is  very  far — the 
collateral  effects  of  the  administration  of  a  given  drug, 
but  even  then  he  proceeds  usually  to  recommend  the  use 
of  the  drug  for  the  relief  of  07ie  of  the  indications  only. 
Let  me  take  as  example  a  familiar  drug,  tobacco,  and, 
opening  the  last  edition  of  perhaps  the  best-ordered  thera- 
peutic guide-book  of  the  day,  we  will  see  what  the  author 
has  to  say  about  its  action  and  uses.  Tobacco  is  stated 
to  act  a  little  (in  what  way  is  not  mentioned)  on  the  brain; 
to  excite  the  spine;  to  lower  the  functional  activities  of 
the  motor  nerves;  to  contract  the  pupils  of  the  eyes;  to 
be  injurious  to  vision;  to  lower  the  temperature;  to  pro- 
duce cardiac  irritability;  frequently  to  cause  dyspepsia, 
and  to  possess  a  slightly  purgative  action.  Then  follows, 
side  by  side  with  the  last  remark,  this  extraordinary  sen- 
tence: "Moderate  smoking  as  a  rule  aids  digestion  by 
acting  as  an  aperient."  Great  heavens  !  an  aperient  ac- 
tion aid  digestion  !  Digestion  a  purely  local  business  ! 
Why,  if  there  be  one  process  of  the  body,  in  the  comple- 
tion of  w^hich  every  organ  is  concerned,  and  the  nervous 
system  most  of  all,  it  is  digestion.  That  a  drug  which 
runs  amuck  in  the  ways  described  among  the  bodily  or- 
gans should  work  anything  but  disaster  in  the  digestive 


THERAPEUTIC    FALLACIES.  103 

function  is  inconceivable  and  ridiculous  on  the  very  face 
of  it.  But  apart  even  from  this  fatal  flaw,  another  and  a 
deeper  error  traverses  the  whole  article  on  tobacco,  one  to 
which  I  have  more  than  once  referred  as  the  fallacy  of  the 
assumed  ideal  standard.  The  writer  of  the  article  has  had 
before  his  mind's  eye  an  ideal  man  with  ideal  organs  and 
with  ideal  surroundings,  and  his  whole  book,  as  indeed  all 
modern  works  on  therapeutics  with  which  I  am  acquaint- 
ed, is  written  for,  and  true  only  in  tbe  case  of,  such  a 
purely  imaginary  being.  The  real  facts,  as  regards  to- 
bacco, are  that  there  exist  many  men  for  whom  tobacco 
is  one  of  the  ordinary  every-day  forces  in  their  environ- 
ment, one  which  their  bodies  have  become  accustomed 
to  balance,  and  one  which  has  therefore  become  an  ele- 
ment in  their  actual  maintenance  of  health  under  the 
conditions  in  which  they  live.  If  they  discontinue  its  use 
their  bodies  actually  become  a  little  deranged  for  a  short 
time,  and  until  accustomed  to  the  want  of  it,  because  one 
power,  though  a  small  one,  in  their  health-producing  sur- 
roundings is  lacking,  just  as  people  unaccustomed  to  the 
effects  of  tobacco  experience  discomfort  on  commencing 
its  use,  because  a  new  power  is  added  to  the  accustomed 
sum  of  forces  in  their  life.  Such  are  a  few  of  the  out- 
rages on  the  human  reason,  a  dozen  samples  of  which  may 
often  be  found  on  a  single  page  of  a  modern  treatise  on 
Materia  Medica. 

I  have  said  that  experiment  is  often  pressed  into  the 
service  of  the  therapeutist,  but  two  grave  errors  invalidate 
the  results  which  one  might  have  looked  for  from  a  prom- 
ising method  of  investigation.  Firstly,  the  experiments 
are  made  nearly  always  on  the  lower  animals,  and,  second- 
ly, they  are  too  partial  to  warrant  the  conclusions  drawn. 
As  to  the  first  of  these  objections  I  have  not  much  to  say, 
nor  do  I  view  it  as  a  disturbing  factor  of  sufficient  weight 


104  THE    TRINCIPLES    OF    SCIENTIFIC    MEDICINE. 

often  to  invalidate  the  results,  inasmuch  as  there  is  oft- 
times  ample  evidence  of  a  close  similarity  of  action  be- 
tween certain  of  the  tissues  in  man  and  in  the  lower  ani- 
mals, though  the  habits  and  customs  of  men  and  animals- 
it  must  be  remembered,  are  widely  different,  and  to  rea- 
son of  the  effects  of  meat  or  tobacco  on  meat-eating, 
smoking  man  from  observations  confined  to  the  vegeta- 
rian, anti-narcotic  monkey  is  scarcely  a  proceeding  likely 
to  advance  science.  But  the  partiality  of  the  experiments, 
at  least  when  viewed  w^th  their  appended  conclusions,  is 
a  much  graver  error,  and  robs  them  absolutely  of  all  real 
value. 

Let  us  take  the  largest  book  of  the  day  on  Pharma- 
cology— and  I  omit  purposely  all  names,  as  I  am  attacking 
an  evil  principle  and  not  an  individual — and  in  every  one  of 
the  very  numerous  experiments  recorded  therein,  one  organ 
or  one  group  or  set  of  organs,  or  even  a  mere  fraction  of 
an  organ,  is  singled  out  as  the  subject  of  a  drug  test,  and 
from  the  results  observed  is  drawn  a  conclusion  as  to  the 
value  of  the  given  medicine  in  a  disease  affecting  the  icJiole 
body  !  But  man  is  not  a  nerve,  a  gland,  a  heart,  a  pair  of 
lungs,  or  a  muscle,  but  a  complete  mechanism,  each  j^art  of 
which  lives  and  performs  a  certain  function,  which  has  no 
real  existence  and  no  useful  purpose  when  viewed  alone,  but 
only  when  regarded  as  an  essential  factor  in  the  mainte- 
nance of  a  certain  general  balance.  Moreover,  it  is  not  ex- 
plained— for  the  explanation,  if  full,  would  in  the  majority 
of  the  cases  show  a  balance  of  utility  against  the  drug, 
even  in  the  special  organ  whose  benefactor  it  is  supposed 
to  be — what  are  the  collateral,  and  above  all  the  second- 
ary, the  after-effects  of  each  drug. 

Sometimes,  indeed,  another  method  of  research,  quite  of 
equal  value  with  the  last,  is  adopted.  A  selected  drug  is 
administered  to  perhaps   a  dozen  individuals  with  some 


FALLACIES    OF    THE    ORTHODOX    DRUG    SYSTEM.        105 

one  symptom.  If  this  symptom  improve  in  all,  or  in  the 
great  majority,  of  such  cases,  the  drug  is  forthwith  given 
out,  iirhi  et  orbi,  as  a  cure  for  such.  To  take  an  example. 
Three  or  four  years  ago,  with  a  great  heralding  of  trump- 
ets, it  was  stated  that,  in  suppression  of  certain  periodic 
female  discharges,  permanganate  of  potassium  (the  salt 
from  which  Condy's  fluid  is  prepared)  was  eminently  suc- 
cessful as  a  means  of  relief.  But  of  the  cases  quoted  it 
was  soon  evident  that,  in  some,  the  suppression  was  phys- 
iological, and  that,  therefore,  no  attempt  to  interfere  with 
it  was  justifiable;  and  apart  from  this  error,  which  is  such 
a  common  one  in  therapeutics  that  I  shall  presently  have 
to  refer  to  it  expressly,  on  extended  research,  and  after 
some  millions  of  women  had  been  dosed  with  this  by  no 
means  harmless  salt,  it  became  clear  that  the  zeal  of  the 
discoverers  had  carried  them  away,  and  that  the  drug  w^as 
practically  inert  in  the  cases  for  which  they  had  recom- 
mended it. 

But  even  if  the  fatal  objections  to  its  credit  which  I 
have  urged  against  the  modern,  orthodox,  therapeutic 
creed  could  be  explained  away,  yet  a  heavier  charge 
would  remain.  Modern  philosojDhy  has  demonstrated  the 
relationship  between  man  and  his  environment,  and  has 
shown  disease  to  be  a  salutary  process  ;  all  symptoms  and 
all  groups  of  symptoms,  and  therefore  all  functional  dis- 
ease, to  be  of  direct  benefit  in  the  restoration  to  health  of 
the  individual ;  organic,  degenerative  disease  being,  as  far 
as  its  lesion  is  concerned,  a  benefit  to  the  race  of  man, 
which  it  purges  of  its  least  fit  members,  Avhjle  its  symp- 
toms retard  the  fatal  issue,  making  death  more  gradual 
and  more  easy  to  the  sufferer.  To  this  view  many  leaders 
in  medicine  have  long  since  subscribed  ;  not  so  the  ther- 
apeutist. To  him  a  symptom  acts  as  does  the  red  rag  on  a 
bull  ;  down  goes  his  head,  and  away,  at  all  costs,  must  the 


106  THE    PRINCIPLES    OF    SCIENTIFIC    MEDICINE. 

objectionable  color.  To  him  a  constipation,  a  diarrhoea,  a 
skin  eruption,  a  heart  that  does  not  beat  the  regulation 
stroke,  or  that  does  not  convey  the  regulation  impression 
to  the  listening  ear,  a  liver  or  a  stomach  that  does  not 
secrete  up  to  a  certain  amount,  are  ever  and  always  legiti- 
mate game.  They  must  conform  to  an  ideal  standard, 
if  twenty  other  organs  fall,  as  a  result,  out  of  the  equi- 
librium, and  a  drug  stimulant  suited  to  that  end  is  select- 
ed ;  whereas  the  real  treatment,  if  treatment  be  needed  at 
all,  should  consist  in  an  effort  to  increase  simultaneously 
the  power  of  all  the  organs,  to  elevate  the  general  equili- 
brium, and  this  can  be  effected  only  by  foods,  by  changes 
of  climate,  by  exercise,  and  similar  means. 

Such  are  a  few  of  the  more  striking  fallacies  of  the  or- 
thodox drug  system ;  nor  is  it  difficult,  by  the  light  that 
their  exposure  sheds,  to  understand  why  this  system  of 
physic  has  become  utterly  discredited,  and  why  educated 
men  so  often  prefer  to  trust  their  lives  in  illness  to  irreg- 
ular practitioners  of  doubtful  honesty  than  to  the  ortho- 
dox physician.  Long  ago  Adam  Smith  said  that  to  the 
quackery  of  the  orthodox  faculty  were  due,  in  England,  all 
other  forms  of  quackery.  As  a  matter  of  fact,  any  system 
of  medicinal  treatment,  or  none  at  all,  succeeds  better  than 
the  orthodox  one.  The  people  at  large  are  unaware  of 
the  fact  that  curable  disease  cures  itself,  and,  moreover, 
takes  the  readiest  and  best  methods  to  attain  that  end. 
Ignorant  intermeddling  on  the  part  of  the  sufferer  with 
the  process  is  the  danger  most  to  be  feared;  the  impostor 
has,  therefore,  but  to  place  the  patient  in  surroundings 
favorable  to  his  recovery,  and  these  in  most  cases  common- 
sense  suggests,  to  occupy  his  time,  and  save  him  from  the 
risks  attendant  on  meddling  with  Nature,  by  giving  him 
some  pleasant  and  inert  compound,  and,  hey  presto  !  health 
returns,  and  the  empiric  reaps  both   reward   and  honor. 


RULES    FOR    ADMINISTRATION    OF    DRUGS.  .  107 

In  vain  does  orthodox  medicine  protest  ;  her  undoubted 
honesty  does  not  save  him  from  the  humiliating  failure 
that  awaits  all  those  who  work  on  wrong  principles. 

It  needs  only  that  some  one  of  our  rising  medical  scien- 
tists should  have  the  courage  of  his  convictions,  and  should 
subject  to  clear  and  pitiless  scrutiny  the  fallacies  on  which 
the  present  drug  structure  is  built,  and  then,  in  the  words 
of  Peisse,  quoted  at  the  commencement  of  this  chajDter, 
"medicine,  while  losing  many  of  her  ambitious  pretensions 
and  of  her  usurped  rights,  would,"  in  return,  "  see  her 
way  clear  in  her  own  domain,  and  could  live  with  security 
and  honor." 

But  it  is  time  for  us  to  consider,  since  common-sense 
authorizes  an  occasional  recourse  to  drugs,  on  Avhat  lines 
and  within  what  limits  we  should  employ  them.  I  can 
attempt  only  a  very  brief  sketch. 

In  the  first  place,  the  cause  of  disease,  which  is  an  un- 
doubted evil,  should  be  sought  for  and  removed.  Some 
drugs  of  the  antidotal  class  can  meet,  in  many  cases,  this 
indication. 

In  the  second  place,  whether  the  cause  be  persistent  and 
irremovable,  or  has  already  been  found  and  placed  out  of 
action,  the  symptoms  of  disease,  being  in  their  very  essence 
of  a  beneficial  nature,  should  be  favored.  This  line  of 
treatment  imitates  Nature,  and  expedites  the  end  she  has 
in  view,  the  cure. 

In  the  third  place,  while  still  imitating  natural  methods, 
it  may  in  rare  cases  be  permissible  to  open  fresh  channels 
of  relief  for  her  by  raising  artificial  symptoms,  similar  in 
nature  and  kind  to  those  already  in  existence,  but  in  a 
part  of  the  body  where  the  mischief  of  ultimate  destruc- 
tion of  tissue  will  be  smaller  than  in  the  structure  affected. 
A  plaster  or  a  stimulating  liniment  may  thus  often  bene- 
ficially be  used  to  congest  or  inflame  the  skin,  and  com- 


108  THE    PRINCIPLES    OF    SCIENTIFIC    MEDICINE. 

pel  it  to  share  in  the  strain  thrown  on  more  deeply  seated 
organs. 

In  the  fourth  place,  stimulating  drugs  should  be  used 
with  caution,  and  with  due  regard  to  the  troublesome  and 
often  serious  reaction  which  is  attendant  on  their  employ- 
ment. Evacuants,  such  as  castor  oil,  should  be  had  re- 
course to  also  occasionally,  but  only  in  emergencies.  Their 
action  always  partakes  somewhat  of  that  of  stimulation,  and 
their  secondary  effects  therefore  nullify  often  the  primary 
and  desirable  purgative  ones. 

In  the  fifth  place,  the  food-adjuncts,  such  as  pepsin,  and 
the  drugs  that  partake  of  the  nature  of  condensed  foods, 
should  be  administered  with  due  regard  to  the  needs  of 
the  body,  and  not  on  the  idle  preconception  that  because 
natural  appetite  is  lacking  it  is  advisable  to  force  it. 
There  is  no  hard-and-fast  line  between  foods  ineptly  given 
and  agents  popularly  recognized  as  poisons. 

Lastly,  drugs  should  be  had  recourse  to  only  when  sim- 
pler means  have  failed,  for  the  knowledge  we  possess  of 
the  complete  action  of  drugs  is  too  restricted  to  justify  us 
in  seeking  of  them  what  is,  at  best,  but  a  questionable  ser- 
vice. All  potent  drugs  should  be  banished  from  the  do- 
mestic medicine-chest. 

The  best  test  we  possess,  though  it  is  by  no  means  an 
infallible  one,  of  the  action  of  a  drug  is  its  behavior  in  a 
number  of  healthy  individual  men.  This  method  of  re- 
search was  that  largely  relied  on  by  the  late  Sir  Robert 
Christison  and  many  other  eminent  therapeutic  authori- 
ties. All  states  of  real  health  are  closely  alike,  are  all 
simply  conditions  of  equilibrium,  and  the  invariable  effects 
of  a  given  drug  in  health,  when  the  experimentation  is 
extensive,  leads  to  some  definite  knowledge  of  its  action, 
and  furnishes  at  least  some  useful  data  for  its  exhibition 
in  disease;  whereas  no  tw^o  states  of  ill-health  can  be  even 


PIIYSICO-MENTAL    AGENTS.  109 

approximately  identical,  for  loss  of  equilibrium  is  neces- 
sarily of  all  shades  and  degrees.  Thus  the  latter  method, 
the  more  specious  and  the  more  fashionable,  is  actually 
the  less  reliable  of  the  two. 

Tlie  PJiysico-mental  Af/e/its  emjyloyed  in  the  Treatment 

of  Disease. 

Before  we  advance,  it  will  be  advisable  to  sum  up  our  posi- 
tion. The  body  of  man  can  be  influenced  either  in  health 
or  in  disease,  thouo-h  the  latter  onlv  of  these  states  now 
concerns  us,  through  the  medium  of  two  channels,  the 
blood  and  the  nervous  system. 

For  the  sake  of  convenience,  we  have  divided  our  agents 
into  ordinary  and  extraordinary.  When  a  patient  pre- 
sents himself  for  treatment  we  generally  turn  first  of  all 
to  the  ordinary  methods  of  relief,  and  if  we  consider  it 
best  to  effect  a  change  in  his  bodily  state  by  acting  on 
his  blood  system,  we  make  what  we  consider  the  alterations 
necessary  to  that  end  in  his  daily  food.*  In  many  cases, 
especially  those  of  chronic  but  slight  illness,  such  a  change, 
if  wisely  and  judiciously  carried  out,  meets  all  the  indica- 
tions for  treatment,  and  health  promptly  returns,  but  in 
some  cases,  from  various  causes,  it  may  partially  or  com- 
pletely fail.  The  body,  for  example,  may  have  been  fight- 
ing hard  for  years  against  antagonistic  forces,  its  gallant 
stand  unappreciated  by  its  owner,  till  at  last,  with  its 
army  of  cells  decimated,  and  the  survivors  exhausted  or 
demoralized,  it  is  forced  to  beat  a  hasty  retreat,  which 
may  threaten  soon  to  end  in  final  and  complete  discomfit- 
ure. Such  is  the  actual  state  of  matters  in  manj^  acute 
diseases  that  the  physician  is  called  on  to  deal  with. 
There  is  absolutely  no  time  to  obtain  aid  from  a  mere 

*  It  must  l3e  remembered  that  the  blood  is  merely  food  Iq  its 
final  state  of  preparation. 


110  THE    PRIXCIPLES    OF    SCIENTIFIC    MEDICINE. 

change  of  diet,  and  a  raj^id  alteration  of  environment  is 
rendered  by  the  patient's  state  impossible.  Something 
must  be  done,  and  done  quickly,  to  prevent  death.  The 
feeble  cells  are  roused  to  renewed  vigor  by  stimulating 
drugs,  while  unnecessary  burdens  are  removed  by  pur- 
gative ones.  Time  is  thus  gained,  and  this  is  employed 
in  endeavoring  to  relieve  the  pressure  of  the  antagonistic 
forces,  and,  if  this  can  be  effected,  the  body  may  be  able 
yet  to  hold  out  against  dissolution,  though  figuratively  at 
its  last  ditch,  for  many  years. 

But  we  may  have  presented  for  our  consideration  and 
advice  an  invalid  whose  dietary  is  perfection,  and  whose 
blood  is,  to  all  intents  and  purposes,  pure.  His  may, 
moreover,  be  a  case  in  which  recourse  to  drugs  is  unadvis- 
able,  and,  be  it  remembered,  the  sick  man  has,  in  any  case, 
to  pay  very  dearly  in  the  end  for  the  temporary  accommo- 
dation derived  from  that  source.  In  such  an  emergency 
we  shall  do  well  to  turn  our  attention  to  his  nervous  sys- 
tem and  investigate  the  daily  impressions  made  on  this. 
These  latter  are  often  inadequate  to  his  bodily  require- 
ments, and  we  therefore  advise  that  a  new  and  stronger 
daily  stimulus  be  applied,  to  -which  end  we  recommend  a 
greater  variety  of  scene,  the  company  of  cheerful  friends, 
an  occasional  visit  to  places  of  amusement,  and,  possibly, 
change  from  monotonous,  dreary,  routine  work  to  employ- 
ment that  calls  for  varied  mental  exercise,  and  that  holds 
before  the  eyes  of  the  worker  some  ambition,  a  something 
worthy  to  work  for  and  to  win.  How  many  apparently 
utterly  hopeless  cases  of  chronic  dyspepsia,  or  of  long- 
standing and  seemingly  incurable  mental  depression,  are 
set  right  by  these  means  ;  how  vast  and  interesting,  but 
too  often  neglected,  this  department  of  rational  treatment, 
and  how  great  and  lasting  its  successes  compared  with 
those  of  the  therapeutist  !     Under  the  heading  of  the  or- 


PLAN    OF    THE    XERVOUS    SYSTEM.  Ill 

dinary  measures  of  treatment  I  have  already  spoken,  in 
climate  and  habit  of  life,  of  some  of  those  nervine  remedies, 
those  of  the  ordinary  variety. 

Let  lis  now  ask  ourselves  if  we  do  not  possess  also  ex- 
traordinary means  of  rapidly  and  suddenly  acting  on  the 
nervous  mechanism  of  man — in  other  Avords,  if  we  cannot 
find  agents  whose  action  on  this  system  is  analogous  to 
that  of  druses  on  the  blood-svstem.  We  shall  see  that  we 
not  only  possess  them,  but  that  they  are  in  frequent  em- 
ployment, though  the  simple  methods  by  which  they  act 
are  generally  misunderstood.  In  order  to  render  their 
action  intelligible  to  the  general  reader,  I  must  precede 
the  enumeration  of  such  extraordinary  nervine  remedies 
by  a  very  brief  sketch  of  the  plan  of  the  healthy  nervous 
system. 

The  nervous  system  consists  mainly  of  bundles  of  nerve 
cells,  the  so-called  nerve  centres,  and  of  two  sets  of  nerves, 
the  one  carrying  impressions,  sensations,  to  the  centres, 
and  hence  called  sensory  or  afferent  {ad,  to,  and/e?*o,  I 
carry)  nerves,  the  other  carrying  motor  influence/rom  the 
centres  to  the  muscles  and  to  the  blood-vessels,  and  these 
latter  are  appropriately  styled  motor,  or  efferent  (e,  from, 
and/ero,  I  carry)  ones. 

The  impression  made  on  the  end  of  the  sensory  nerve 
travels  to  its  centre,  sets  up  certain  changes  in  the  cells 
there,  and,  as  a  result,  causes  an  emission  of  motor  energy* 
down  the  motor  nerve,  which  either  contracts  the  cells  of 
a  muscle  and  thus  causes  a  limb  to  move,  or  alters  the 
size,  the  state  of  contraction,  in  the  cells  of  a  blood-vessel, 
and  thus  leads  to  an  increase  or  decrease  in  the  supply  of 
blood  to  a  part,  and,  since  the  blood  is  the  cell  food,  the 
material  by  union  with  which  it  performs  its  work  in  life, 

*  Each  nerve  cell  is  a  storehouse  of  energy,  which,  like  the  heat- 
energy  of  the  muscle  cells,  is  derived  solely  from  food. 


112  THE    PRINCIPLES    OF    SCIENTIFIC    MEDICINE. 

consequently  to  an  increase  or  a  decrease  in  the  functions 
of  the  part. 

The  number  of  such  nerve  centres  is  very  large.  There 
are  hundreds  scattered  through  the  body  whose  function 
is  nothing  more  than  what  I  have  sketched.  Each  one 
with  its  afferent  and  efferent  nerves  is  as  purely  an  auto- 
maton as  one  of  the  machines  for  supplying  matches  and 
sweetmeats  to  be  seen  at  the  railway  stations.  They  are 
aptly  called  reflex  centres,  inasmuch  as  their  sole  function 
in  health  is  to  reflect  impressions,  and  in  response  to  a 
stimulation,  a  call,  from  any  portion  of  the  body,  to  send 
down  by  the  motor  nerve  an  amount  of  energy  equal  to 
such  stimulation,  which  expends  itself  in  dilating  the  local 
blood-vessels  and  thus  temporarily  increasing  the  local 
power  of  doing  w^ork.  This,  in  brief,  is  the  nervous  mech- 
anism by  virtue  of  which  all  of  our  internal  organs  per- 
form, without  the  direct  interference,  or,  in  health,  without 
even  the  knowledge,  of  the  brain,  those  manifold  func- 
tions— breathing,  digesting,  heart-movement,  etc.— which 
are  necessary  to  life. 

It  must,  however,  be  added  that  each  one  of  the  many 
reflex  centres  in  the  body  is  connected  also,  indirectly, 
with  the  brain,  which  thus  becomes  conscious  of  a  sensa- 
tion— pleasurable  or  painful — when  the  stimulating  mes- 
sage travelling  from  any  organ  to  its  reflex  centre  is  in.  ex- 
cess of  the  ordinary.  Thus,  for  example,  though  we  are, 
in  the  ordinary  wa}^,  absolutely  unconscious  of  the  inces- 
sant movements  in  the  coils  of  the  intestine,  any  indigest- 
ible article  of  diet  will  speedily  afford  to  us  a  painful 
proof  of  their  reality  ;  and,  moreover,  this  sensation,  going 
to  the  brain,  will  be  reproduced,  as  are  all  such  impres- 
sions, in  the  form  of  motion,  and  thus  new  groups  of  mus- 
cles, in  this  case  those  of  the  abdominal  wall,  are  set  in 
movement  and  aid  in  the  expulsion  of  the  undesirable  guest. 


THE    BRAIN    AND    ITS    NERVE    CENTRES.  113 

Let  US  now  turn  to  that  most  important  and  complex 
nerve  centre,  the  brain,  for  on  a  conception  of  its  mode  of 
working  will  depend  our  comprehension  of  the  manner  in 
which  external  impressions  of  various  kinds  may  be  util- 
ized as  remedial  agents  of  a  highly  important  character. 

In  ground-plan  the  human  brain  may  be  said  to  be  an 
aggregation  of  reflex  centres,  each  receiving  a  specii^lized 
impression,  each  emitting  ordinary  motor  force  as  a  con- 
sequence thereof.  Thus  we  have  the  centres  for  sight,  for 
hearing,  for  smelling,  for  tasting,  and  for  feeling,  together 
with  many  others,  mention  of  which,  for  the  sake  of  sim- 
plicity, we  must  here  omit.  Now,  it  is  perfectly  certain 
that  the  impressions  which  are  represented  in  the  human 
brain  by  vision,  by  sounds,  by  odors,  by  sapid  substances, 
and  by  contact  with  the  skin,  are,  each  and  al),  the  result 
of  the  impact  on  certain  parts  of  the  body  of  matter  in 
some  one  of  its  well-known  forms,  and  that  the  flnal  and 
wide  difference  in  the  impressions  conveyed  to  the  brain 
are  due  merely  to  differences  in  the  forms  and  the  move- 
ments of  such  matter,  and,  most  of  all,  to  the  special  ap- 
paratus, situated  at  the  termination  of  each  sense-nerve 
and  on  which  the  impression  first  falls.  In  short,  there 
can  be  no  doubt  as  to  the  absolute  materiality  of  the  im- 
pressions, of  the  existence  of  special  apparatus  for  receiv- 
ing and  specializing  them,  and  of  their  final  exit  from  the 
brain  as  motor  force  capable  of  setting  any  part  of  the 
body  in  action. 

Each  nerve  centre  in  the  brain,  though  occupying  a  dis- 
tinct area  and  being  to  a  large  extent  a  separate  entity, 
has  nevertheless  important  relations  with  all  the  others, 
for  the  impressions  (called,  in  the  brain,  the  sensations)  it 
receives,  ere  their  final  exit  as  motion,  blend  with  those 
from  other  centres,  and  thus  produce  w^hat  we  know  as  an 
"  association  of  ideas,"  and  from  this  compounding  of  sen- 


114  THE    PRINCIPLES    OF    SCIENTIFIC   MEDICINE. 

sations  naturally  arises  an  equivalent  blending  in  the  re- 
sulting motor  currents,  and  hence  such  really  comj^lex 
raovements  as  those  of  speech,  music -playing,  dancing, 
etc. 

The  above  slight  sketch  will  suffice  to  outline  the  way 
in  which  external  and  purely  material  impressions,  acting 
on  the  impressionable  sense  organs,  influence,  and,  indeed, 
command  the  brain,  which,  in  its  turn,  holding  in  its  hands 
the  reins  of  the  whole  body,  may  in  response  set  muscles 
or  limbs  in  motion,  or  contract  blood-vessels  and  decrease 
their  local  functional  activity,  or  may  employ  one  motor 
energy  to  counterbalance  some  other  motor  energy,  and 
thus  dilate  blood-vessels  and  increase  muscular  functions, 
or  check  —  in  physiological  language,  "inhibit"  —  some 
movement  that  would  otherwise  have  taken  place. 

Such  then  are  some  of  the  ordinary  powers  of  the  brain, 
whose  existence  is  placed  by  innumerable  direct  experi- 
ments beyond  the  pale  of  doubt,  and  which  are  common 
alike  to  man  and  to  the  higher  animals. 

Thus  we  see  that,  in  addition  to  the  food  channels,  the 
arteries,  we  possess  in  the  nerves  of  the  special  senses  five 
great  channels,  by  acting  upon  which  we  may  influence  at 
will  each  and  every  part  of  the  bodily  mechanism,  pro- 
vided only  that  the  cells  of  the  brain,  and  of  the  rest  of 
the  body,  be  fairly  supplied  with  their  proper  store  of  en- 
ergy by  the  food  system,  which  is  after  all  the  first  and 
most  essential  of  all  the  systems,  and  literally  and  truly 
the  source  of  life. 

The  reader  will  now,  w^ithout  difiiculty,  be  able  to  un- 
derstand how  very  easily,  since  the  movements,  the  func- 
tions, and  the  very  life  of  each  and  every  organ,  and 
portion  of  an  organ,  are  under  the  direct  control  of  that 
great  nervous  mechanism,  tlie  brain,  we  may,  by  applying 
suitable  stimuli  to  the  sense  organs,  increase,  decrease,  or 


THE    BRAIN    AND    ITS    NERVE    CENTRES.  115 

regulate  the  activity  of  any  part  of  the  body,  and  how  sim- 
ply it  happens  that  the  stern  voice  and  the  fixed  glances 
of  the  mesmerist  can  throw  into  a  cataleptic  state  the 
limbs  of  the  patient,  or  hold  the  brain  functions  of  the 
latter  temporarily  in  his  power.  Given  an  impressionable 
set  of  nerve  organs  and  a  definite  number  and  variety  of 
impressions  acting  upon  them,  and  the  result  is  certain. 
The  operator  does  not  control  the  patient  by  his  will,  as 
for  the  greater  mystification  of  the  people  he  would  fain 
have  them  believe,  but  by  the  purely  material  agency  of 
words  and  glances  ;*  for  were  the  phenomena  witnessed 
due  to  any  psychic,  any  spiritual,  agency,  it  is  quite  clear 
that  the  operator  could  dispense  with  all  words  of  com- 
mand and  glances.  Certain  localities  are  also  capable  of 
a  powerful  influence  over  the  bodies  of  some  individuals, 
and  the  connection  between  cause  and  effect  is  precisely 
the  same  as  in  the  case  of  mesmerist  and  subject.  The 
solemn  surroundings  of  such  places  are,  to  the  eyes  of  the 
pilgrims,  what  were  the  glances  of  the  mesmerist,  and  the 
wonderful  stories  of  the  benefits  received  are  the  exact 
analogues  of  his  words  of  command,  the  direction  thus 
given  to  the  nerve  currents  resulting  in  the  one  case  in 
rigidity  of  limbs,  or  the  performance  of  comical  actions, 
in  the  other  in  the  return  of  power  to  weakened  organs  or 
in  the  healing  of  obstinate  ulcerations.  The  thoughtless 
public  do  not  know  that  it  is  simply  and  solely  owing  to 
the  limited  powers  of  the  human  eye  that  the  real  cause 
of  the  wonders  observed,  the  impact  of  material  impres- 
sions on  the  sense  organs,  and  thence  on  the  brain  cells  of 
the  affected,  is  not  actually  visible,  though  its  existence  is 

*  Faith  iu  the  operator  is  usually  considered,  and  is,  indeed,  a 
powerful  aid  towards  success.  It  would  seem  to  consist  in  a  condi- 
tion of  the  brain  in  which  the  inhibitory  mechanism  already  referred 
to  is  in  a  state  of  quiescence. 


116  THE    PRINCIPLES    OF    SCIEXTIFIC    MEDICIXE. 

as  demonstrable  and  as  tangible  as  is  that  of  the  vapor  of 
absolute  alcohol,  of  chloroform,  or  of  ether,  which,  though 
invisible,  can,  at  the  will  of  the  administrator,  convert  a 
quiet  and  harmless  individual  into  a  dangerous  madman, 
or  place  speech  and  moveinent  beyond  the  control  of  the 
subject. 

It  is  then,  I  consider,  clearly  the  duty  of  medicine  to 
rescue  from  the  hands  of  impostors  these  very  powerful 
means  of  affecting  for  good  or  for  ill — for  they  are  equal- 
ly potent  for  both — the  body  of  man,  and  to  formulate  the 
nature  and  scope  of  their  employment.  In  such  a  treatise 
as  this  I  can  do  little  more  than  mention  a  few  of  the 
methods  in  common  use  to  restore  health  through  the 
nervous  mechanism. 

Of  these,  electricity  is  the  first  in  importance.  Very 
rarely  indeed  is  this  potent  agent  applied  to  the  nerves  of 
vision,  hearing,  smell,  or  taste,  or  to  the  brain  tissue  it- 
self ;  its  use  is  restricted  almost  purely  to  the  restoration 
of  lost  or  defective  motor  and  sensory  nerve  currents.  Of 
the  four  forms  in  which  it  is  employed,  that  known  as 
static  electricity,  or  Franklinism,  is  the  most  generally  use- 
ful, the  most  easily  applied,  the  safest,  and  the  least  known 
to  the  public.  The  electric  force  is,  for  this  purpose,  gen- 
erated by  friction,  the  Toepler-Holtz  apparatus,  with  its 
large  circular  glass  plates,  which  forms  so  prominent  a 
feature  in  physical  laboratories,  being  the  instrument  gen- 
erally used  in  its  production.  It  may  be  applied  to  the 
whole  body,  when  it  may  be  said  to  cause  a  general  exal- 
tation of  functions,  or  mild  stimulation,  of  use,  backed  up 
by  surer  means,  in  the  treatment  of  hysteria,  hystero-epi- 
lepsy,  nervous  exhaustion,  and  even  in  some  varieties  of 
real  epilepsy;  or  its  application  may  be  localized,  and  its 
stimulating  properties  centred  on  one  or  more  groups  of 
muscles  or  other  organs.     In  this  way  wry-neck,  contract- 


ELECTRICITY    AS    A    NERVINE    STIMULANT.  117 

ures  of  limbs,  spastic  rigidity,  and  some  forms  of  paraly- 
sis and  of  St.  Vitus's  dance,  may  be  relieved  or  even  per- 
manently cured. 

Next  in  utility  as  a  means  of  treatment,  comes  the  dy- 
namic form  of  electricity.  This  is  usually  generated  by 
the  conversion  of  chemical  energy,  as  the  static  variety  is 
by  that  of  friction  energy,  to  electric  energy.  Dynamic 
electricity  supplies  us  with  the  means  of  burning  tissue 
(electro -cautery),  or  of  more  slowly  disintegrating  it 
(electrolysis),  and  is  the  usual  agent  employed  in  those 
portable  baftteries  that  produce  the  familiar  "  shocks," 
though  sometimes  the  electric  force  is,  in  these  cases,  de- 
rived from  a  magnet,  the  name  of  electro-'inagnetism  being 
then  given  to  the  results  of  this  combination. 

In  the  second  part  of  this  work,  which  will  deal  with 
the  Art  of  Healing,  I  shall,  where  necessary,  enter  into 
detail  as  to  the  means  of  applying  electric  force  in  disease. 
In  this  place  I  will  ask  the  reader  to  observe  that,  in  elec- 
tricity, we  possess  an  agent  which  is  capable,  among  other 
uses,  of  being  employed  to  rouse  any  part  of  the  nervous 
system,  excepting  the  special  nerves  of  vision,  of  hearing, 
of  taste,  and  of  smell.  When  it  is  desirable  to  act  on 
these,  other,  and  what  are  generally  regarded  as  more 
mysterious,  agents  have  to  be  found.* 

In  7nesmerism^  as  I  have  already  explained,  we  possess  a 
potent  method  of  influencing  the  whole  body  by  acting 
directly  on  the  brain.  ITypnotism,  so  much  in  vogue  as  a 
therapeutic  agent  in  Paris  at  the  present  day,  is  but  mes- 
merism.    It  cannot  be  denied  that,  extraordinary  as  are 

*  While  -writing  this  my  eyes  fell  on  the  following  paragraph- 
lieading  in  the  Lancet  of  July  28,  1888,  "Recovery  of  Vision  by 
Lightning;"  under  which  is  given  an  account  of  the  restoration  of 
sight  by  the  sudden  stimulation  of  the  retina  of  the  eye  by  an  elec- 
tric flash,  a  most  instructive  and  suggestive  lesson. 


118  THE    PRINCIPLES    OF    SCIENTIFIC    MEDICINE. 

often  the  benefits  derived  from  the  use  of  this  agent,  there 
exist  great  drawbacks  to  its  frequent  employment,  for, 
while  it  has  recalled  many  a  sufferer  from  chronic  nerve 
debility  to  health,  it  has  also  sent  a  large  number  across 
the  border  ipto  the  realms  of  insanity.  There  can  be  no 
doubt  that  extended  study  will  enable  us  to  better  regu- 
late the  strength  of  impression,  and  that  science  may  even 
provide  us  with  a  mechanical  mesmerist;  and  an  instru- 
ment producing  the  necessary  kind  and  variety  of  impres- 
sion on  the  sense  organs  is  well  within  the  limits  of  me- 
chanical skill;  but  in  the  meantime  this  agent  is  liable  to 
great  misuse,  all  the  more  as  it  is  in  the  power  of  every 
one  readily  to  become  more  or  less  of  a  successful  opera- 
tor with  it;  and  for  this  reason  it  should  seldom,  and  only 
with  certain  safeguards,  be  had  recourse  to. 

Faith-healing  is  an  agent  closely  allied  in  its  rationale 
with  mesmerism.  The  glances  of  the  mesmerist  are  re- 
placed by  the  equally  potent  agents  of  impressive  sur- 
roundings, the  stacks  of  crutches,  etc.,  to  the  influence  of 
which  the  optic  apparatus  of  the  invalid  is  exposed,  and 
the  words  of  command  by  the  narratives  of  those  who 
have  witnessed  or  themselves  experienced  the  eflicacy  of 
the  cure.  As  in  the  mesmeric  performance,  so  in  the  proc- 
esses of  faith-healing,  belief  is  insisted  on  as  a  sine  qua 
non.  Faith  in  God,  which  implies  faith  in  the  operator, 
or  the  locality,  which  are  to  be  viewed  as  tools  in  his 
hand,  is  the  first  essential.  I  have  had  the  advantage  of 
meeting  and  conversing  with  many  who  have  profited  by 
faith-healing,  and  I  have  also  read  more  than  one  well- 
authenticated  work  on  the  subject,  and,  while  I  am  con- 
vinced of  the  truth  of  the  results,  which  are  usually,  how- 
ever, somewhat  exaggerated,  I  have  never  seen  any  reason 
whatever  for  regarding  them  as  divine  or  miraculous.  In 
fact,  the  best  and  most  }>ermanent  case  I  have  ever  wit- 


CURES    "by    impressions."  119 

nessed  of  a  cure  by  impressions  was  that  of  a  bedridden 
woman*  who  was  restored  suddenly  and  com[)letely  to 
healthy  vigor  by  the  intelligence  that  her  husband  had 
been  arrested  and  imprisoned  for  stealing. 

It  is  most  instructive  in  this  connection  to  note  how  well 
the  ancients  understood  the  power  of  sudden  impressions 
made  on  the  nervous  system.  Look  at  their  methods  of 
curing  insanity.  The  unlucky  patient  was  well  beaten,  or 
was  hung  head  downward,  or  was  nearly  drowned,  but, 
unless  we  are  prepared  to  say  that  there  was  an  organized 
conspiracy  to  lie,  the  desired  result  was  often  attained. 
Indeed,  the  ancients  were  closer  observers  of  cause  and 
effect  than  we  are,  and  it  is  simply  incredible  that  such 
cruelty  would  have  received,  as  it  did,  official  sanction 
unless  there  existed  some  really  substantial  evidence  in  its 
favor.  About  eight  years  ago  there  was  reported  by  the 
medical  officer  of  a  northern  asylum,  in  either  the  Lancet 
or  the  British  Medical  Journal,  the  case  of  a  woman  un- 
der his  charge,  who,  after  having  for  years  suffered  from 
insanity  of  an  inveterate  and  apparently  incurable  type, 
had  completely  recovered  her  reason  after  being  resusci- 
tated from  apparent  death  due  to  a  most  determined  effort 
to  strangle  herself. 

Of  course,  such  methods  of  cure  are  not  commendable, 
nor  indeed  are  they  probably  as  successful  as  the  more 
modern  and  humane  ones,  but  the  study  of  them  teaches 
us  the  useful  lesson  that  a  stimulation  of  the  nervous  sys- 
tem, even  if  painful,  may  be,  and  often  is,  beneficial  in 
diseases  that  no  drug  can  touch,  and  that  no  ordinary 
means  can  hope  to  effect. 

Faith-healing  then,  like  kindred  agencies,  may  now  and 

*  She  had  been  six  years  in  bed  with  functional  paralysis,  and  her 
case  had  been  regarded  as  hopeless  by  many  doctors  who  bad  at- 
tended her. 


120  THE    PRINCIPLES    OF    SCIENTIFIC    MEDICINE. 

again,  in  well-selected  cases,  be  pressed  into  the  service  of 
the  physician. 

We  now  turn  to  almost  the  only  means  of  the  class  we 
are  considering  of  which  modern  medicine  will  take  offi- 
cial cognizance — namely,  3Iassage.  Massage  differs  from 
both  mesmerism  and  faith-healing,  inasmuch  as  it  not  only 
provides  the  patient  with  healthy  mental  and  physical 
pabulum,  but  also  aids  recovery  by  removing  deleterious 
influences.* 

The  state  of  matters,  in  the  case  of  invalids  for  whom 
massage  is  advisable,  is  often  much  as  follows:  The  pa- 
tient, usually  an  impressionable  female,  is  surrounded  by 
a  sympathizing  crowd  of  friends  and  attendants,  almost 
the  sole  subject  of  conversation  being  the  state  of  the 
real — more  often  supposed — disease  under  which  the  suf- 
ferer labors.  From  these,  and  often  from  the  doctors, 
come  many  unwise  questions,  such  as — Have  you  no  pain 
here,  no  tenderness  there  ?  These  questions  in  the  debili- 
tated mind  of  the  patient  take  the  form  of  suggestions, 
and  new  crops  of  symptoms  are  the  result,  and  a  complete 
physical  and  mental  demoralization  ensues. 

In  these  cases,  massage  acts  like  a  charm.  The  patient 
is  isolated,  the  flow  of  baneful  sympathy  is  arrested  and 
replaced  by  the  firm  words  of  direction  and  of  hope  of 
the  professional  rubber.  Recovery,  as  a  subject  of  con- 
versation, replaces  valetudinarianism.  In  addition,  the 
body  is  kneaded  in  all  directions,  and  the  accumulations 
of  waste  in  the  unused  muscles  and  the  current  of  blood 
in  the  capillaries  are  hurried  forward,  the  kidneys  excrete 
more  freely,  and  appetite  returns  naturally.  Nourishment 
is,  after  the  first  day  or  two,  freely  supplied,  and  in  the 
course  of  a  few  weeks  both  the  blood  and  the  nervous 


*  I  refer  here  to  "general  massage" — i.  e.,  massage  of  the  wbolr 
body. 


THE    USE    AND    ABUSE    OF    MASSAGE.  121 

system  have  recovered  their  normal  state,  and  the  cure  is 
complete. 

Sometimes  the  patient  is  one  of  those  despondent,  intro- 
spective, hypochondriacal  males,  nearly  always  the  subject 
of  chronic  neurotic  dyspepsia. 

In  massage  we  then  possess  a  rational  and  most  excellent 
means  to  bring  what  we  have  called  an  extraordinary  in- 
fluence, or  combination  of  influences,  to  bear  beneficially 
on  an  advanced  derangement  of  the  nervous  system  ;  un- 
fortunately, the  system  has  been,  and  is,  discredited  by  the 
unscrupulous  use  that  is  frequently  made  of  it  to  unjusti- 
fiably deplete  the  pockets  of  the  rich,  the  extraordinary 
nature  of  the  remedy  being  used  as  a  lever.  It  can  be 
carried  out  thoroughly,  at  really  very  little  expense,  by 
any  conscientious  nurse  to  whom  a  few  lessons  in  manipu- 
lation, and  on  the  rationale  of  the  process,  have  been  given. 

And  now  the  first  half  of  our  allotted  task — that  which 
deals  with  the  great  underlying  principles  on  which  the 
existence  of  man  rests — approaches  completion.  Let  us 
once  dispassionately  view  the  human  being  as  he  really  is, 
a  bodily  substance  intricate  and  complex  indeed  in  the  ar- 
rangement of  its  several  parts,  but  none  the  less  purely 
physical  in  both  structure  and  function,  and  keep  ever 
steadily  before  our  eyes  the  relationship  which  must  exist 
between  it  and  every  other  embodiment  of  force  in  its  vi- 
cinity, and  we  shall  discern  clearly  what  health  is,  and  on 
what  its  maintenance  must  depend — an  equilibrium  be- 
tween the  sum  of  the  bodily  and  of  the  surrounding  forces. 
Secure  on  this  firm  principle,  it  will  be  easy  to  trace  the 
source  of  nearly  every  derangement,  and,  comprehending 
thus  the  real  causation  of  bodily  disorder,  and  possessing 
the  key  to  the  right  interpretation  of  the  phenomena,  the 
symptoms  manifested  in  the  course  of  it,  the  sure  road 
6 


122  TUE    PRINCIPLES    OF    SCIENTIFIC    MEDICINE. 

to  a  simple  and  scientific  method  of  treatment  will  be- 
come plain  and  easy. 

Such  is  my  idea  of  a  rational  system  of  medicine  ;  too 
conscious  in  its  own  strength  to  feel  the  pangs  of  jealousy 
or  to  dread  the  advent  of  rivalry  ;  too  anxious  for  its  own 
perfection  to  discountenance  truth  from  any  quarter ;  too 
wholesome  to  breed  quackery;  too  secure  in  its  hold  on  the 
human  reason  and  too  single-minded  in  its  aims  to  doubt 
its  own  honor  or  its  hold  on  the  gratitude  and  affection  of 
the  human  race.  Such,  when  the  time  comes,  will  be  the 
gospel  of  medicine,  and,  if  I  interpret  aright  the  prevailing 
spirit  of  dissatisfaction  regarding  the  present  medical 
creeds,  as  well  in  the  circles  of  the  educated  and  thought- 
ful public  as  in  those  of  the  medical  world,  its  advent  can- 
not long  be  delayed.  My  attempt  is,  compared  with  such 
an  effort,  quite  unambitious,  more  to  write  down  in  the 
spare  moments  of  the  day  a  sketch  of  what  rational  medi- 
cine should  be,  and  thus  possibly  to  act  as  the  not  alto- 
gether unworthy  forerunner  of  a  greater  man. 


PART     II. 

TRE  ART  OF  HEALING, 


mXEODUCTIOR 


We  now  approach  the  practical  application  to  the  phys- 
ical derangements  of  humanity  of  the  principles  of  our 
science  of  medicine. 

The  human  body  is,  as  we  have  seen,  not  a  mere  aggre- 
gation of  independent  or  semi-dependent  organs,  each  pur- 
suing selfishly  its  own  course,  but  a  perfect  mechanism  of 
nicely  adjusted  and  interdependent  portions,  producing  a 
real  concert  of  functions  emitting  in  health  but  one  har- 
monious tune.  If,  then,  for  purposes  of  study,  a  grouping 
of  such  organs  becomes  necessary,  it  will  be  advisable  to 
make  our  definition  of  each  group  as  wide  and  inclusive  as 
possible,  and  to  base  it  on  the  sure  ground  of  physiological 
knowledge.  What,  we  ask,  does  the  body  of  man  ?  First- 
ly, it  lives  and  moves,  by  virtue  of  the  supply  to  its  cells 
of  material  with  which  those  cells  can  so  act  as  to  pro- 
duce those  phenomena  ;  let  then  our  first  division  com- 
prise all  the  organs  concerned  in  the  food  system.  Sec- 
ondly, it  regulates  its  internal  economy  and  its  relations 
^ith  the  external  world;  let  then  our  second  group  include 
the  organs  concerned  in  bodily  government  under  the  term 
nervous  system.  Thirdly,  it  possesses  a  system  of  fulcra 
and  levers,  the  bones  and  muscles,  which  constitutes  its 
inotor  system.  This  we  must  next  study.  Fourthly,  and 
lastly,  it  reproduces  itself,  and  therefore  we  shall  have  to 
say  a  few  words  on  the  reproductwe  system. 


126  INTRODUCTION. 

Grouping  thus  the  bodily  organs  in  the  only  rational 
manner  in  which  any  grouping  of  the  parts  of  a  perfect 
mechanism  is  permissible,  according  to  their  duties,  and 
not  in  the  ordinary  method,  geographically,  according  to 
the  regions  of  the  body  which  they  chance  to  occupy,  or, 
still  more  absurdly,  according  to  the  alphabetical  order  of 
the  initial  letters  of  their  names,  we  shall  be  able  to  trace, 
without  I  hope  anj^  very  great  difficulty,  many  apparently 
disconnected  phenomena  of  ill-health,  having  but  the  one 
origin,  and  requiring  therefore  but  the  one  line  of  treat- 
ment. 


Ko.  i.—Ubc  foo^  system* 


CHAPTER   YI. 
SOURCES  AND  DESTINY  OF  HUMAN  FOODS. 

1.  The  Foods  of  Man,  Iheir  Origin,  their  Digestion, 

and  their  Uses. 

2.  The  Processes  of  Digestion. 

3.  The  Organs  of  the  Food  System. 


Ube  foot)  System. 


CHAPTER   YL 
SOURCES  AND  DESTINY   OF  HUMAN  FOODS. 

Ix  our  first  chapter  we  saw  that  the  body  of  man,  or, 
more  correctly,  the  living  cells  of  his  body,  requires  two 
varieties  of  food,  tissue-food,  represented  by  albumen,  by 
chemical  union  with  which  these  cells  live  and  multiply  ; 
and  fuel-food,  represented  mainly  by  the  fats,  starches, 
and  sugars,  from  the  combustion  of  which,  by  the  oxygen 
in  the  blood,  the  cells  derive  heat-energy  to  enable  them 
to  perform  their  various  duties  in  life. 

Inorganic  salts  also  are  required  to  assist  the  above 
chemical  processes,  and  water  to  hold  the  food  in  solution. 

All  the  above-named  substances  must  be  presented  to 
the  cells  as  crystalloids;  the  salts  and  the  water  are  already 
of  this  nature,  but  the  albumens  and  the  fuel-foods  are 
colloids,  and  therefore,  ere  they  can  be  utilized  as  cell- 
foods,  must  be  converted  to  crystalloids — must,  in  other 
words,  undergo  a  process  called  digestion. 

Let  us  now  consider,  in  a  little  more  general  detail,  the 
foods,  the  digestive  process,  and  the  parts  assigned  to  the 
different  organs  of  the  food  system  in  the  body. 
6* 


130  SOURCES    AND    DESTINY    OF    HUMAN    FOODS. 

1.  The  Foods. 

(1)  The  albumens^  or  tissue-foods,  the  material  whose 
chemical  union  with  the  cells  is  the  actual  physical  cause 
of  the  phenomena  known  collectively  as  growth  and  main- 
tenance, must  approach*  in  complexity  of  structure  and 
in  composition  to  the  cells  themselves,  and  a  substance 
fulfilling  such  conditions  can,  as  we  might  expect,  only  be 
found  in  organisms  that  have  themselves  lived.  Now  in 
the  scale  of  life  the  animals  come  far  before  the  plants,  for 
every  part  of  their  structure,  except  the  fat  deposit,  may 
be  said  to  enjoy  a  share  of  life;  in  every  part  of  them 
therefore,  with  the  exception  named,  do  we  find  the  albu- 
minous substance  called  protoplasm,  fitted  to  act  as  a  tissue- 
food.  In  the  vegetable  kingdom  this  is,  however,  not  the 
case,  the  seeds  only  possessing  a  large  share  of  that  life 
essence,  albumen,  while  the  rest  of  the  structure  contains 
it  but  in  small  proportion. 

The  bodies  of  animals  and  the  seeds  of  plants  are  thus 
our  main  sources  of  albumen  or  tissue-food. 

(2)  The  fuel-foods,  represented  by  the  fats,  starches,  and 
sugars,  whose  destiny  in  man's  body  it  is  simply  to  under- 
go combustion,  and  thus  to  supply  it  with  that  motor  power 
which,  like  a  steam-engine,  it  derives  from  heat-energy, 

*  The  energy  of  a  living  cell  is  dependent  on  complexity  of  struct- 
"<ire.  "When  a  new  cliemical  compound,  on  which  it  can  act,  is  pre- 
sented to  it,  the  resultant  has  a  composition  which  is  a  mean  of  the 
complexity  of  the  two.  In  order,  therefore,  that  such  chemical  in- 
terchange should  for  long  continue— in  other  words,  that  cell  life 
should  last — it  is  clear  that  the  cell-food  must  approximate  in 
composition  somewhat  closely  to  the  cell  itself,  for,  if  not,  that  zero 
of  simplicity  of  structure  which  bars  further  change  because  it  is 
stable  would  too  soon  be  reached,  and  death  would  prematurely 
ensue. 


THE    FOODS.  131 

are,  compared  to  the  albumens,  simple  compounds,  analo- 
gous in  chemical  structure  to  our  ordinary  fuels — wood, 
coal,  oil,  etc. — and  are  derived  from  those  parts  of  the 
members  of  the  animal  and  vegetable  kingdom  which  have 
never  enjoyed  life.  Therefore  they  are  represented  in  the 
animal  section  only  by  the  one  substance,  fat,  all  our  other 
necessary  supplies  of  starch,  sugar,  and  vegetable  fat  be- 
ing drawn  from  the  trunks,  branches,  leaves,  sap,  and  fruits 
of  the  vegetable  world,  as  also  from  that  portion  of  the 
seeds  which  is  destined  to  act  as  pabulum  to  the  albumi- 
nous germ. 

(3)  The  Salts  and  Water. — Of  these,  as  I  am  not  writ- 
ing a  complete  physiological  treatise,  and  do  not  wish  to 
burden  the  minds  of  my  readers,  I  shall  merely  say  that,  as 
regards  the  former,  common  salt  is  the  chief  necessary 
member  of  the  salt  group,  and  as  to  the  latter,  that  water 
enters  largely  into  the  composition  of  our  solid  foods,  and 
that  it,  even  in  its  simple  condition  as  water,  contains  usual- 
ly many  of  the  necessary  salts  in  varying  amounts.  With 
regard,  furthermore,  to  the  latter  fluid,  it  must  be  added 
that  the  small  micro-organisms  usually  found  in  it  are 
not — if  they  be  of  the  ordinary  kind — evils,  but  distinct 
benefits,  having  very  important  effects  as  aids  to  the  di- 
gestive process.  From  time  immemorial  has  man  con- 
sumed them,  and,  as  in  everything  else,  the  body  has 
conformed  to  its  environment,  nor  can  a  single  item  in 
the  latter  be  disturbed  without  such  interference  throw- 
ing the  body  out  of  balance.  Modern  science  echoes 
every  day  more  and  more  plainly  those  words  in  the 
Book  of  Genesis  :  "And  God  saw  all  the  things  that  he 
had  made,  and  they  were  very  good.'''' 

II.   TJie  Digestive  Process. 
This  consists  simply  in  the  conversion  of  insoluble  {and 


132  SOURCES    AND    DESTINY    OF    HUMAN    FOODS. 

th&t'efore  iinassimilable)  colloid  foods  to  the  crystcdloid 
form. 

The  process  is  effected  by  means  of  ferments  prepared 
in  different  organs  of  the  body,  and  is  exceedingly  simple, 
each  ferment  having  the  power  of  adding  one  molecule  of 
water  to  each  molecule  of  the  food  on  which  it  acts.  This 
suffices  to  change  a  colloid  form  of  food  to  a  crystalloid 
one. 

Now  we  saw  in  our  first  chapter  that  a  crystalloid  dif- 
fers from  a  colloid,  inasmuch  as  when  dissolved  in  w^ater  it 
can  penetrate  all  living  cells,  and  can  therefore  flow  through 
all  animal  membranes  composed  of  such  cells. 

Such  is  the  digestive  process  in  all  its  completeness, 
exceedingly  simple,  and  yet,  as  we  shall  see,  equal  to  the 
many  parts  it  has  to  play. 

Let  us  study  these  various  roles. 

Digestion  of  Alhimien. — Albumen  is  a  colloid  on  enter- 
ing the  body.  In  the  mouth  it  undergoes  no  change  ;  in 
the  stomach  it  is  acted  on  by  a  ferment  (pepsin),  and  in 
the  upper  part  of  the  bowel  by  another  prepared  from  the 
pancreas  (trypsin),  and  as  a  result  of  these  actions  it  be- 
comes changed  to  a  soluble  crystalloid  form  of  albumen 
(a  peptone),  which,  by  virtue  of  its  new  nature,  glides 
through  the  animal  membranes  lining  the  stomach  and 
bowel,  and  enters  the  fine  blood-vessels  (capillaries)  which 
ramify  there.  From  these  vessels  such  soluble  albumen 
would  have  the  power  of  escape,  as  it  had  the  power  of 
entry,  were  it  not  that  (probably)  a  sudden  re-conversion 
of  it  into  an  insoluble  colloid  here  takes  place,  the  extra 
molecule  of  water,  by  virtue  of  which  it  could  traverse  the 
living  membranes,  being  lost  in  the  passage  through  them, 
or  being  claimed  by  the  blood.  Our  albumen  has  now  en- 
tered a  channel  of  the  great  food-stream,  the  blood,  and 
cannot  escape  therefrom  ;  on  it  goes  in  this  current  direct 


DIGESTION    OF    ALBUMEN.  133 

to  the  liver.  Here  it  meets  walls  of  living  cells,  and,  be- 
ing a  colloid,  is  arrested.  This  is  an  imjoortant  stage  in 
its  career.  Part  of  it  is  now  oxidized  to  urea,  uric  acid, 
and  bile  acids,  while  the  rest,  the  larger  part,  is  again  di- 
gested*— i.  e.,  has  its  molecules  of  water  restored  to  it — 
and  passes  on  into  the  great  general  blood-stream  once 
more  as  soluble  crystalloid  albumen  (serum  of  blood). 
But  why  does  not  this  soluble  albumen  escape  from  the 
blood-vessels  in  Avhich  it  now  finds  itself  ?  The  current  of 
blood  is  too  large  and  swift,  and  the  coats  of  the  blood- 
vessels are  too  many  and  too  thick.  So  it  travels  to  the 
right  side  of  the  heart,  thence  to  the  lungs,  and  back  to 
the  left  side  of  the  heart,  whence  it  is  pumped  into  the 
large  arteries.  Now  it  approaches  its  goal ;  the  big  ar- 
teries divide  and  subdivide,  until,  at  last,  our  traveller 
finds  itself  circulating  again  in  thin-walled  capillaries,  run- 
ning this  time  among  the  living  cells.  Out  of  the  blood- 
channel  it  passes  and  enters  the  cells.  Now  take  place 
between  cell  and  albumen  those  chemical  chancres  and 
that  liberation  of  energy  which  I  have  often  referred  to, 
and  which  constitute  cell -life,  cell-growth,  and  cell-repro- 
duction. But  this  action  involves  the  formation  of  waste, 
of  bye-products.  These  debris  pass  out  of  the  cells  in  the 
form  of  amides,  amines,  and  amido-acids  (which  quickly 
are  all  converted  to  urea  and  uric  acid),  to  enter  inter- 
spaces which  open  into  lymphatic  ducts,  these  empty  them- 
selves into  veins,  and  the  urea  and  uric  acid,  together  with 
the  similar  products  formed  by  the  liver,  are  conducted  to 
the  kidneys,  and  thence  to  the  bladder,  to  be  eventually 
voided  with  the  urine. 

Such  then  has  modern  science  shown  the  disrestion  of 
albumen  to  be,  a  process  so  very  simple  as  to  be  within 

*  By  the  arterial  blood  which  enters  the  liver  by  the  hepatic  artery. 


134  SOURCES    AXD    DESTINY    OF    HUMAN   FOODS. 

the  comprehension  of  all.  Let  us  now  review  the  changes 
which  the  fuel-foods  undergo,  and  these  will  be  found  to 
be  even  less  complicated. 

Digestion  of  the  Fuel-foods. — (A)  Starch. — This  is  a  col- 
loid, but  in  the  mouth  it  has  added  to  each  of  its  mole- 
cules one  molecule  of  water,  by  means  of  a  ferment  (ptya- 
lin)  existing  in  the  saliva.  It  is  thus,  in  large  part,  changed 
to  a  crystalloid  called  grape-sugar,  and  as  such  it  is  swal- 
lowed. Whatever  part  of  the  starch  consumed  may  have 
escaped  digestion  in  the  mouth,  passes  through  the  stom- 
ach, and  in  the  upper  part  of  the  bowel  comes  in  contact 
with  a  ferment  (amylopsin),  differing  in  name  from,  but 
identical  in  power  with,  that  formed  by  the  saliva,  and 
which  completes  the  necessary  conversion  to  grape-sugar.* 
Thus  the  colloid  starch  of  our  food  is  represented  in  our 
stomach  and  intestine  by  crystalloid  grape-sugar.  This 
enters  the  capillaries  as  did  the  soluble  albumen,  is  there 
in  a  similar  way  robbed  of  its  extra  particle  of  water,  and 
becomes  again  a  colloid  (glycogen),  and  as  such  reaches 
the  liver  and  is  arrested. f  This,  as  was  seen  to  be  the 
case  also  in  albumen,  is  an  important  stage  also  in  the 
journey  of  this  fuel-food.  Here  the  glycogen,  or,  as  it  is 
sometimes  called,  "  animal  starch,"  is  stored.  Now,  the 
liver  is  the  only  organ  of  the  body  that  has  tioo  distinct 
blood  supplies,  and  the  special  need  for  this  will  now  be 
apparent.     The  glycogen  has  travelled  to  the  liver  by  the 

*  The  intestinal  glands  secrete  a  fluid  that  liolds  ferments  that  can 
complete  the  digestion  of  those  albumens  and  fuel-foods  which  have 
run  the  gantlet,  unscathed,  of  the  first  ferments,  but  their  action  is 
slight  and  too  unimportant  to  need  mention  in  a  short  sketch. 

f  It  is  a  matter  of  dispute  icliere  glycogen  is  formed.  Many  phys- 
iologists hold  that  the  liver  itself  prepares  it  from  the  grape-sugar, 
but  more  modern  views  incline  to  the  view  that  this  change  is  com- 
menced before  the  liver  is  reached. 


DIGESTION    OF    THE    FUEL-FOODS.  135 

portal  vein,  which  collects  all  the  soluble  food  from  the 
bowel,  but  the  hepatic  artery,  also  going  to  the  liver,  has 
the  function  of  nourishing  the  cells  of  that  structure,  and 
the  blood  which  it  contains  holds  a  ferment  which  can 
once  more  (by  adding,  of  course,  the  necessary  extra  mole- 
cules of  water)  convert  insoluble  glycogen  to  soluble  grape- 
sugar;  but  this  latter  ferment  is  present  only  in  small  quan- 
tities, and  therefore  the  general  blood  system  going  from 
the  liver  to  the  heart  is  supplied,  slowly  and  regularly 
only,  with  a  small  supply  of  grape-sugar  from  the  great 
reserve  store  of  glycogen  in  the  liver,  the  latter  organ  be- 
ing, as  it  were,  a  coal-scuttle  from  which  the  fire  in  the 
tissues  is  constantly  and  regularly  supplied  with  the  neces- 
sary amount  of  fuel  to  keep  it  at  a  fixed  heat.  What  be- 
comes of  the  grape-sugar  that  is  thus  sent  on  into  the  gen- 
eral circulation  ?  It  is  oxidized — i.  e.,  gently  burned — by 
the  oxygen  that  is  taken  up  by  the  blood  in  its  passage 
through  the  lungs.  The  precise  locality  where  combus- 
tion takes  place  is  not  accurately  known  ;  whether  this 
grape-sugar  is  conveyed  to  the  cells  as  was  the  albumen, 
and  is  actually  there,  or  in  that  neighborhood,  consumed, 
or  whether  the  combustion  is  more  general,  is  uncertain  ; 
but  it  is  certain  that  the  heat-energy  evolved  is  stored  by 
the  living  cells,  and  that  the  products  of  combustion,  which 
are  the  same  as  those  of  a  perfectly  burned  piece  of  coal  or 
wood,  carbonic  acid  and  water,  are  cast  out  of  the  body, 
the  former  by  the  lungs,  the  latter  by  the  kidneys,  lungs, 
and  skin. 

(B)  Cane-sugar,  milk-sugar,  dextrine,  and  gum  are,  like 
starch,  converted  to  grape-sugar,  and  follow  an  identical 
course.  Cane-sugar  and  milk-sugar  are,  however,  not  col- 
loids. 

(C)  Fat.  This  colloid  substance  passes  both  the  mouth 
and  the  stomach  without  undergoing  any  kind  of  diges- 


136  SOURCES    AND    DESTINY    OF    HUMAN    FOODS. 

tion.  On  reaching  the  upper  portions  of  the  bowel  it 
comes  into  contact  with  the  bile,  which,  dissolving  the 
coats  of  the  small  fat  globules,  converts  the  fat  into  a 
milky,  but  still  colloid,  substance,  as  which  it  is  taken  up 
by  the  open  mouths  of  the  minute  lacteal  ducts  with  which 
the  bowel  is  lined,  and,  journeying  thence  through  the 
lymphatic  glands  of  the  abdomen,  passes  to  certain  ducts 
which  empty  themselves  into  the  blood-current,  where  it 
undergoes  storage  in  the  tissues,  and  eventually,  like  grape- 
sugar,  combustion,  the  products  of  which,  as  carbonic  acid 
and  water,  are  excreted.* 

Some  small  portion  of  the  fat  would  seem,  however,  to 
undergo  a  real  digestion,  similar  to  that  of  starch,  by  the 
action  of  certain  pancreatic  ferments  called  emulsion  and 
steapsin,  and  in  an  altered  form  (as  glycerine  and  fatty 
acids)  to  reach  the  liver,  but  this  point  is  yet  suhjtulice. 

Finally,  the  salts  and  loater,  needing  no  digestion,  being 
already  crystalloids,  travel  through  the  bowel  wall,  the 
liver,  and  the  body  cells,  without  let  or  hindrance,  the 
precise  utility  of  the  salts — and  they  are  essentials  to  life 
— being  still  a  subject  of  chemical  investigation. 

As  fuel-foods,  the  starches  and  sugars  in  their  readiness 
for  combustion  come,  then,  first.  Then  follow  the  fats 
which,  unless  the  oxygen  supply  exceed  the  starch  and 
sugar  supply,  tend  to  be  rather  deposited  in  the  tissues 
than  at  once  consumed.  Finally,  it  must  be  added  that 
all  albuminous  food  that  is  absorbed  undergoes  a  primary 
oxidation  process,  and  thus  in  part  is  utilized  as  a  fuel- 

*  Fat  thus  would  seem  to  form  an  exception  to  our  rule  of  diges- 
tion. It  is,  however,  a  great  question  whether  it  does  so.  Recent 
experiments  seem  to  show  that  (dl  the  colloid  fat  absorbed  is  stored 
as  fat  in  the  body  and  forms  thus  a  reserve  fuel-food,  which,  accord- 
ing to  bodily  needs,  is  converted  by  the  blood  to  a  crystalloid  form 
and  burned. 


THE    ORIGIN    OF    THE    DIGESTIVE    FERMENTS.  137 

food,  but  it  can  never  answer  for  long  as  a  substitute  for 
the  other  fuel-foods,  since  the  products  of  combustion  of 
albumen  include  such  nitrogenous  substances  as  urea  and 
uric  acid,  which,  when  present  in  constant  excess,  hamper, 
and  finally  break  down,  the  excretory  powers  of  the  kid- 
neys to  Avhich  they  go,  and  thus  lead  to  disasters  to  be  de- 
scribed in  future  pages. 

As  to  the  origin  of  the  digestive  ferments.  These  are 
extracted — i.  e.,  prepared — from  the  blood  by  the  salivary 
glands  of  the  mouth,  the  peptic  glands  of  the  stomach, 
and  the  pancreatic  and  intestinal  glands,  while  the  emulsi- 
fying principle  in  the  bile  is  derived  from  the  same  source. 
Hence  we  reach  the  first  great  truth  about  digestion — viz., 
that  a  nor^nal  state  of  the  blood  is  essential  to  good  diges- 
tion^ while,  later  on,  we  shall  see  that,  to  the  same  end, 
there  exist  but  two  other,  minor  conditions,  to  wit,  a  nor- 
mal state  of  the  nervous  system  and  an  absence  of  degen- 
eration in  the  digestive  organs  themselves,  though  it  is 
open  to  question  whether  in  the  presence  of  the  first  con- 
dition, either  of  the  latter  can,  to  any  great  extent,  exist. 

Then  there  are  certain  further  adjuncts  to  digestion,  to 
which  a  few  words  must  be  devoted.  Mastication  is  the 
first  of  these.  That  starch  should  be  long  retained  in 
the  mouth  and  thoroughly  broken  up  there  is  intelligible 
enough,  but  in  the  case  of  albumen  and  fat,  over  which 
the  saliva  has  no  power,  the  need  for  mastication  is  evi- 
dently not  so  great,  and  carnivorous  animals,  as  we  know, 
naturally  bolt  their  food.  Secondly,  the  muscular  power 
of  the  stomach  and  bowels,  which  has  the  effect  of  pre- 
senting all  the  different  parts  of  the  aliment  they  contain 
to  the  action  of  the  digestive  fluids,  is  an  important  aid  to 
digestion,  and  must  not  be  lost  sight  of.  Lastly,  the  in- 
testine undertakes  the  removal  from  the  body  of  all  food 
or  other  material  consumed  in  excess  of  the  digestive  power. 


138  SOURCES    AND    DESTINY    OF    HUMAN    FOODS. 

We  now  approach  the  last  of  the  three  subjects  which 
this  chapter  is  designed  to  elucidate,  namely  : 

III.   Tlie  Organs  of  the  Food  System. 

These  comprise  the  mouth  and  its  salivary  glands  ;  the 
stomach  and  its  peptic  glands  ;  the  intestine  with  its  pan- 
creatic and  other  numerous  small  glands  ;  the  portal  vein 
and  its  tributaries,  which,  having  the  special  function  of 
conveying  food  stuffs  from  the  bowel  and  the  stomach  to 
the  liver,  deserves  to  be  considered  apart  from  the  general 
blood-stream  ;  the  liver  ;  the  blood-channels  and  heart ; 
the  lungs,  whose  function  is  to  take  in  oxygen  for  union 
with  the  foods,  and  to  emit  the  carbonic  acid  and  water, 
the  products  of  that  combination  ;  the  lymphatic  ducts 
and  glands  ;  the  skin  ;  the  kidneys  and  bladder.  To  these 
fall  to  be  added  certain  organs  of  vague  function,  of  which 
the  most  important  is  the  spleen.  We  are  now  in  a  posi- 
tion to  discuss  intelligibly  the  diseases  due — (1)  to  defects 
in  the  food  supply  ;  (2)  those  due  to  faults  in  digestion  as 
a  process  ;  and  (3)  those  due  to  disease  of  the  organs  con- 
cerned in  the  food  supply. 


CHAPTER  VII. 

DISEASES   DUE   TO   DEFICIENCY   OF   FOOD. 


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Treatment  of  all  grades  of  deficiency. 

1.  Supply  digestible,  nourishing,  simple  food  in   proportion  to 

sufferer's  needs  and  powers,  exercising,  at  first,  in  advanced 
cases,  the  greatest  caution. 

2.  Supply  oxygen,  by  means  of  fresh  air,  to  consume  such  food, 

and  to  thus  render  it  available  for  the  bodily  requirements. 

3.  Supply  exercise  sufiicient  to  the  removal  of  all  food  waste  from 

the  muscles. 

4.  See  that  clothing,  occupation,  and  habits  of  life  be  suited  to 

the  bodily  needs. 


XT  be    ifOOb    ^^5tCm—{contmue(7). 


CHAPTER  VII. 

DISEASES   DUE   TO   FOOD. 
(a)  to  deficiency  of  food. 

If  the  human  body  be  deprived  of  all  food  for  many 
days,  or  if  the  food  obtainable  be  of  an  exceedingly  dry 
nature  and  necessary  water  be  withheld — which  amounts 
to  the  same  thing,  since  food  is  valueless  to  man  in  the 
absence  of  water  to  dissolve  it — starvation  sets  in,  death 
resulting  when  the  body  has  lost  about  40  per  cent,  of  its 
ordinary  health  weight. 

The  actual  sequence  of  matters  in  acute  starvation  of 
that  kind  is  as  follows:  The  reserve  of  serum  albumen  in 
the  blood  and  that  of  starch  in  the  liver  and  of  fat  in  the 
tissues  are  first  used  up,  and  then,  to  keep  the  flame  of 
life  still  burning,  the  living  cells  themselves  are  drawn  on, 
until  a  point  is  reached  which  is  incompatible  witli  fur- 
ther existence. 

The  more  striking  symj^toms  of  acute  starvation  are 
cravinr/  for  food,  a  gnaicing  pain  in  the  region  of  the 
stomach,  both  of  which  symptoms  subside  in  two  or  three 
days,  insatiable  and  continuous  thirst,  sleejylessyiess,  pcdlor, 
loss  of  iceight,  a  tendency  to  deconijyositioii  of  the  tissues, 


142  DISEASES    DUE    TO    DEFICIENCY    OF    FOOD, 

indicated  by  the  fetid  smell  of  the  breath  and  sweat,  great 
prostration  ending  in  torjyor,  delirium,  and  convulsions, 
which  latter  symptoms  are  indicative  of  the  starvation  of 
the  nerve-cells  of  the  brain. 

Death  from  deprivation  of  both  food  and  water  occurs 
in  about  six  days,  but  the  suj^ply  of  even  minute  quanti- 
ties of  food,  or  even  of  water  only,  may  prolong  life  for 
several  weeks. 

The  signs  of  starvation  may  be  commonly  witnessed  in 
prolonged  fevers  :  e.  g.,  in  typhoid  fevei*,  many  of  the  ad- 
vanced symptoms  of  which  are  more  due  to  deprivation 
of  food — a  deprivation  which  the  conditions  of  life  in 
fevers  render  us  often  impotent  to  rectify — than  to  other 
causes.  One  rare  fever,  relapsing  or  famine  fever,  is  due 
to  little  else  than  starvation,  and  prevails  only  in  times  of 
great  destitution,  though  the  presence  of  a  minute  organ- 
ism (Spirochcete  Ohermeierii)  in  the  blood  of  the  sufferers 
is  accountable  for  some  of  the  symptoms  witnessed,  and 
for  the  epidemicity  of  this  disorder. 

A  few  words  on  treatment.  We  know  that  in  all  cases 
of  starvation  water  has  a  remarkable  power  of  prolonging 
life.  It,  like  the  necessary  salts,  some  of  which  it  also 
contains,  is  a  crystalloid,  and  therefore  can  pass  without 
challenge  the  tissues,  which,  in  fever,  bar  the  way  to  the, 
in  that  condition  of  matters,  indigestible  and  insoluble 
colloids.  Let,  then,  the  fever  patient  have  the  water  for 
which  his  body  urgently  calls,  to  his  heart's  content,  and, 
in  the  name  of  common -sense,  let  him  have  ordinary 
drinking-water,  with  its  useful  salts  and  its  ordinary  mi- 
cro-organisms. I  have  scores  of  times  seen  the  modern 
nurse,  in  her  ignorance  of  nature  and  of  real  science,  do- 
ing her  best  to  substitute  a  stone  for  bread,  by  sedulously 
administering  to  the  sufferer  some  bottled  px(re  water,  or 
water  deprived  by  boiling  or  by  distillation  of  much  of 


THE    TREATMENT    OF    STARVATION.  143 

its  nutriment.  Warmth  again  is  as  useful  as  water,  for  if 
we  can,  by  lessening  loss  by  radiation,  economize  the  bod- 
ily heat,  it  is  evident  that  we  shall  succeed  in  reducing 
considerably  the  results  which  flow  from  want  of  fuel- 
foods,  for  death  by  starvation  is  partly  death  by  cold. 
Rest  will  further  the  same  desirable  end,  since  fuel-foods 
supply  the  body  with  motor  power  as  well  as  heat. 

The  treatment  of  starvation  —  whether  witnessed  in 
fevers  or  in  other  cases — consists  then  in  warmth,  rest, 
and  the  cautious  administration  of  such  foods  as  can  be 
assimilated.  In  fevers,  water  and  bland  fluids,  whey,  and 
fruit,  by  reason  of  the  crystalloid  salts  which  they  con- 
tain, may  be  given  in  the  worse  cases.  Colloid  foods,  even 
if  artificially  digested,  must  be  given  only  in  the  smallest 
amounts,  for  digestion  is  not  a  mere  passage  through  the 
wall  of  the  stomach  and  intestine,  as  most  manufacturing 
chemists  seem  to  think,  but  a  multiple  function  continued 
long  after  the  foods  have  passed  successfully  that  first 
stage.  The  administration  of  albumens,  starches,  sugars 
(which  become  colloids  in  the  liver),  and  fats  must  be 
graduated  nicely  to  the  severity  of  the  fever,  while  in  ordi- 
nary cases  of  simple  starvation  they  may  be  given  cautious- 
ly when  the  first  stages  of  debility  have  been  overcome. 

Slow  starvation  is  one  of  the  commonest,  as  it  is  often 
also  one  of  the  least  suspected,  causes  of  ill-health.  It  is 
generally  the  result  of  a  deficient  supply  of  food  only,  but 
may  be  also  due  to,  and  is  always  aggravated  by,  debility 
of  the  stomach  and  bowels,  impurity  of  that  great  diges- 
tive fluid,  the  blood,  want  of  a  proj^er  supply  of  oxygen,  or 
want  of  the  important  waste  remover,  exercise.  It  is  of 
many  grades  of  severity;  sometimes  so  slight  as  to  induce 
only  chronic  debility,  ofttimes  also  is  it — especially  at  cer- 
tain stages  of  bodily  growth,  when  a  full  supply  of  food 
becomes  more  than  ever  necessary — the  exciting  cause  of 


144  DISEASES    DUE    TO    DEFICIENCY    OF    FOOD. 

some  rapid  disease,  and  especially  of  Consumption,  which 
terminates  life  without  exciting  any  suspicion  as  to  the 
real  cause  underlying  its  appearance. 

In  bahy-life  death  by  slow  starvation  is  exceedingly 
common,  even  the  healthiest  and  most  robust  children 
succumbing  in  numbers  to  its  attacks,  and  this  because 
the  real  needs  of  a  baby  in  the  way  of  food  are  often  mis- 
understood, the  symptoms  of  slow  starvation  being  held 
to  mean  some  internal  derangement — rare  and  almost  im- 
possible as  can  be  a  serious  derangement  in  the  properly 
fed  infant — calling  for  treatment,  rather  than  actual  want. 

The  signs  of  baby-starvation  are  as  follows :  Firstly, 
there  \%  fretfulness ;  secondly,  there  is  icasting ;  thirdly, 
there  appear  vomiting  and,  \x%\x2i\\j^  purging^  which  gradu- 
ally increase  in  severity,  for,  as  the  stomach  weakens,  the 
improper  food  administered  (and  usually  it  is  a  food  indi- 
gestible in  kind  rather  than  deficient  in  amount  which 
underlies  the  derangement)  becomes  more  and  more  un- 
suited  to  the  digestive  capacity,  and  is  rejected  with 
greater  and  greater  frequency.  As  a  symptom  that  the 
process  of  starvation  has  affected  seriously  the  nerve  mech- 
anism, convulsions  appear  towards  the  last  and  terminate 
the  scene. 

And  it  must  be  confessed  that  the  fatal  termination  is 
generally  hastened  by  various  well-meant  but  ignorant 
procedures.  The  fretfulness  is  thought  to  be  due  to  tem- 
per, and  a  narcotic  is  given;  the  wasting  is  regarded  as  a 
sign  of  some  grave  disorder  (usually  of  consumption  of 
the  bowels),  and  as  such  is  duly  treated;  the  vomiting  and 
diarrha*a  are  thought  to  be  sj^mptoms  of  the  same  fancied 
disease  or  due  to  teething,  while  the  convulsions  are  inter- 
preted to  mean  anything  or  everything  except  what  they 
really  indicate,  starvation  of  the  nervous  system. 

IVie  treatment  is  simple,  but  its  application  requires  tact 


SIGNS    OF   SLOW    STARVATION.  145 

and  some  little  knowledge.  Whatever  the  stage  of  the 
complaint,  the  food  given  must  be  of  a  kind  which  the 
stomach  can  digest,  and  must  be  nicely  suited  to  the  pres- 
ent condition  of  weakness.  If  the  case  be  a  severe  one, 
barley  water,  rice  w^ater,  or  wdiey,  sweetened  to  increase 
their  nourishing  power,  should  form  for  a  day  or  two  the 
sole  nourishment.  Poor  as  are  such  substances  in  nutri- 
tious ingredients,  they  are  probably  each  richer  than  the 
very  tiny  quantities  of  the  other  foods  which  the  child's 
stomach  has  been  able  to  retain.  Then,  as  diarrhcea  and 
vomiting  subside,  a  gradual  advance  is  made;  a  table- 
spoonful  of  cows',  or  a  salt-spoonful  of  condensed,  milk  is 
added  to  each  bottle,  or  a  very  weak  solution  of  Benger's 
farinaceous  food  may  be  given  twice  a  day.  Increasing 
the  food  strength  in  accordance  with  the  child's  increas- 
ing digestive  power,  it  is  usually  easy  to  restore  the  suf- 
ferer to  complete  health  without  the  least  aid  from  drugs. 

I  have  spoken  so  far  of  healthy  babies,  but  when  the 
unfortunate  infant  is  born  with  the  heritage  of  scrofula 
or  of  syphilis,  it  can  easily  be  understood  how  the  special 
weaknesses  and  deformities  of  such  maladies  will  com- 
plicate the  troubles  and  increase  the  chances  of  a  fatal 
termination. 

In  later  cJdldhood,  from  two  to  ten  years  of  age,  a  dis- 
crepancy between  demand  and  supply  in  the  food  will  man- 
ifest itself  in  general  weakness,  and,  in  bad  cases,  in  bend- 
ing of  those  bones  upon  which  most  w^eight  is  thrown,  i.  e., 
in  Rickets;  sometimes  even  in  Consumption,  which,  com- 
mencing in  the  abdomen  or  the  brain,  will  secondarily  af- 
fect the  lungs  and  the  whole  body. 

I71  adolescence,  from  ten  to  twenty-one  years  or  so,  a 
period  fraught  with  special  dangers  has  to  be  faced. 
Rapidity  of  growth,  considerable  mental  and  physical  ef- 
fort, and  last,  and  most  important  of  all,  the  awakening 
7 


146  DISEASES    DUE    TO   DEFICIENCY    OF    FOOD. 

of  a  new  and  important  system,  the  reproductive  one, 
make  special  demands  on  the  body  for  a  large  supply  of 
food — i.  e.,  of  energy— to  meet  the  emergencies  of  the 
period.  Not  only,  however,  is,  at  this  time,  suitable  and 
nutritious  food  demanded,  but  the  necessary  adjunct  to 
food,  oxygen,  must  be  secured  to  enable  the  body  to  draw 
from  the  food  its  hidden  forces,  and  this  is  obtainable  only 
by  abundant  exercise  in  pure  air. 

When  either  or  both  of  these  requisites,  food  and  oxy- 
gen, fall  at  this  time  of  life  short  of  the  bodily  demand,  a 
train  of  special  and  peculiar  symptoms  is  witnessed.  In 
young  women.  Hysteria,  languor,  deficiency  or  absence  of 
periodic  discharge,  a  pallor  of  the  skin  approaching  the 
hue  of  tallow,  great  hreathlessness,  and  severe  indigestion 
are  the  usual  signs  of  physical  distress,  and  if  exercise  and 
fresh  air  have  been  deficient,  while  food  has  been  supplied 
in  plenty,  a  considerable  deposit  of  fat  over  the  body  will 
also,  and  very  naturally,  be  witnessed;  but,  on  the  other 
hand,  should  food  and  fresh  air  both  have  been  deficient, 
and  the  physical  exertion  excessive,  loss  of  weight  will  ac- 
company the  languor,  hreathlessness,  and  other  symptoms, 
and  Consumption  of  the  lungs  may  make  its  appearance. 

In  young  men,  while  consumption  at  this  period  is  as 
common  as  in  young  women,  and  often  due  to  the  same 
cause,  a  deficient  supply  of  food  does  not  lead  to  so  much 
pallor — a  pasty  rather  than  a  tallowy  hue  being  observa- 
ble— nor  to  hreathlessness;  dyspepsia  is,  however,  as  com- 
mon a  symptom  as  in  females,  while  Hypochondriasis  often 
replaces  the  hysteria. 

There  is  no  man  to  whom  the  grave  seems  so  near  and 
so  terrible  as  to  the  male  adolescent  dyspeptic.  He  runs 
in  a  state  of  great  trepidation  through  the  gamut  of  fan- 
cied disease,  selecting  the  gravest,  and,  at  his  age,  the 
least  likely.     His  conscience  is  morbidly  acute,  and  woe 


CONSEQUENCES    OF   DEFICIENT    FOOD.  14*7 

betide  him  if  he  fall,  in  this  state,  a  prey  to  the  quack. 
The  crops  of  acne  on  the  face  and  back  will  then  be  rep- 
resented to  him  as  due  to  syphilis  ;  the  palj)itation,  to 
heart  disease;  the  vertigo,  to  coming  insanity;  the  dys- 
pepsia, to  liver  disease  or  to  phthisis. 

A  real  insanity  of  puberty  is,  however,  a  recognized  and 
not  an  uncommon  form  of  mental  disorder,  attendant  often 
directly  on  lack  of  food  and  of  oxygen.  It  is,  though  an 
alarming,  not  a  very  serious  complaint,  and  is  the  direct 
result  of  anaemia  of  (^.  e.,  poverty  of  blood  in)  the  brain- 
cells.  In  every  specimen  of  it  that  I  have  witnessed,  a 
little  knowledge  and  ordinary  care  might  have  prevented 
the  attack,  which  in  every  case  has  been  eventually  re- 
covered from.  It  may  be  added,  lest  my  words  alarm  the 
hypochondriac,  that  in  these  cases  of  mental  disorder  there 
is  neither  before  the  attack,  nor  at  the  time  of  it,  any  anx- 
iety of  mind  on  the  part  of  the  patient,  the  mental  con- 
dition being  one  either  of  torpor  or  of  exhilaration,  and 
thus  contrasting  strongly  with  the  gloomy,  foreboding 
disposition  of  hypochondriasis. 

I71  middle  life,  privation,  especially  if  but  slight,  has  no 
symptoms  sufficiently  specialized  to  indicate  clearly  its 
existence.  It  may,  in  common  with  many  other  causes, 
be  a  factor  in  the  production  of  consumption,  or  again  in 
that  of  insanity,  or  even  of  gout,  but,  certainly  among 
neurotic  females,  and  even  occasionally  among  males,  of 
the  upper  class,  a  train  of  remarkable  symptoms,  marked 
by  loss  of  flesh,  morbid  irritahility,  despondency,  and  great 
genercd  ivecikness,  all  the  result  of  starvation  of  the  ner- 
vous system,  are  commonly  w^itnessed,  and  invariably  dis- 
appear, when,  under  a  course  of  massage,  food  in  good 
quantities  is  administered  and  its  digestion  rendered  pos- 
sible by  that  mechanical  exercise  of  the  muscles  which 
massage  insures. 


148  DISEASES   DUE    TO    DEFICIENCY    OF   FOOD. 

In  old  age  the  evils  of  privation  are  seen  less  frequently 
of  all,  and  at  tlieir  minimum.  No  doubt  a  lack  of  fuel- 
foods  at  this  time  leads  often  to  suffering  from  cold,  es- 
pecially when  the  bodily  covering  is  so  defective  in  nature 
and  amount  that  heat  is  rapidly  lost  by  radiation,  but  the 
demands  of  the  body  for  tissue-food  are  relatively  so 
small  that  slow  starvation  as  a  cause  of  death  is,  at  this 
period,  certainly  uncommon.  Danger  at  this  time  of  life 
generally  comes  from  an  opposite  direction — from  an  ex- 
cess of  food. 

What  remedy,  then,  shall  we  adopt  for  a  deficiency  in 
necessary  food  in  the  last  four  periods  of  life  mentioned  ? 
The  administration  of  food?  No;  that  alone  is  quite  in- 
sufficient. Food  and  the  ineaois  of  digesting  it  are  both 
essential,  and  the  latter  are  to  be  sought  in  a  good  oxygen 
supply — I.  e.,  in  fresh  air — and  in  a  due  renewal  of  waste 
by  means  of  exercise. 

Drugs  are  worse  than  useless.  No  doubt,  in  the  anoemia 
of  young  women  at  puberty,  iron  will  often  improve  mat- 
ters, but  if  good  air  and  good  food  can  be  secured,  even 
the  use  of  that  drug  may  beneficially  be  omitted. 

But  what  about  diet-tables — how  many  ounces  of  albu- 
men, of  fat,  of  starch,  of  water,  and  how  many  drachms 
of  salt  per  diem,  should  be  taken  at  these  different  periods 
of  life?  There  is  not  any  answer  to  such  a  question. 
When  the  day  comes  that  all  individuals  of  the  same  age 
are  of  the  same  size  and  weight,  and  have  been  brought 
up  in  the  same  habits,  then  it  will  be  of  use  to  humanity 
to  have  such  a  table  of  dietaries,  to  learn  it  by  heart,  and 
to  pass  laws  making  it  penal  to  disobey  it ;  but  at  the 
present  day,  weight,  that  is,  the  weight  of  the  living  por- 
tions of  man — which  may  roughly  be  said  to  be  that  of  a 
man,  minus  his  fat,  for  fat  does  not  eat  or  live — is,  as  we 
all  know,  at  similar  periods  of  life  subject  to  wide  varia- 


THE  FOOD  DEMANDS  OF  THE  BODY.         149 

tions,  and  to  say  that  the  six  trillions  of  living  cells  in  A 
demand  the  same  nourishment  as  the  ten  trillions  in  B  is 
as  absurd  as  to  assert  that  the  necessary  food  for  an  army 
of  600,000  is  the  same  as  that  for  one  of  1,000,000  men. 
Then  vre  have  to  consider  the  oft-neglected  question  of 
habit.  What,  in  the  way  of  food,  are  the  habits  of  your  in- 
dividual— ^.  e.,  of  his  cells,  of  the  units  of  your  army  ?  And 
everything  that  feeds,  be  it  remembered,  has  certain  food 
limits  within  which  habit  can  operate,  providing  it  does  so 
gradually,  without  destruction  of  health,  A  full-feeding 
man  will  lose  weight  and  strength  rapidly  on  a  dietary 
upon  which  a  laborer  of  similar  weight  and  age  can  retain 
both;  our  prison  records  are  fruitful  in  examples  of  men 
who  have  lost  their  lives  because  their  bodies  would  not 
bow  to  the  hard-and-fast  limits  of  food  upon  which  the 
half-starved  refuse  of  our  towns  had  maintained  health, 
and  which  Red-tape  had,  in  defiance  of  Kature,  decreed 
as  the  amount  on  which  all  men  can  subsist. 

I  repeat  then,  as  the  sole  rough  guide  to  a  physiological 
dietary  that  I  can  conceive,  the  following  rules,  given 
already,  with  their  defence,  in  Chapter  IV.,  and  I  must 
add  that  even  the  application  of  these  should  be  checked 
by  that  other  great  factor  in  every  calculation  that  applies 
to  man — habit, 

I,  Per  unit  weight  of  living  tissue,  the  demand  for  albu- 
men (tissue-food)  falls  steadily,  in  the  condition  of  health, 
from  birth  to  death,* 

II,  As  far  as  can  be  judged  from  the  study  of  the  most 
reliable  diet-tables,  the  demand  for  tissue-food  per  pound 
weight  f   of   body  is,  at  birth,  about  2    grammes  or  30 

*  It  is  instructive  here  to  remember  that  the  heart-beats  of  the 
newly  born  infant  are  also  double  in  number,  per  minute,  those  of 
old  age. 

f  Here,  for  the  sake  of  simplicity,  I  speak  of  individuals  of  aver- 


150  DISEASES    DUE    TO    DEFICIENCY    OF    FOOD. 

grains,  and  in  extreme  old  age,  about  lialf  that  amount; 
the  intermediate  periods  of  life  exhibiting  in  this  respect, 
from  birth  to  death,  a  steady  decline  of  from  -^  to  ^  of  a 
grain,  per  pound,  per  year. 

III.  In  the  case  of  the  fuel-foods,  the  diet-tables  also  in- 
dicate an  equally  steady  fall  in  the  same  direction,  but  the 
computation  of  the  relative  amounts  is  more  difficult,  since 
the  value  of  fat  as  an  article  of  diet,  as  compared  vrith 
that  of  starch,  is  as  17  to  10.* 

Taking,  however,  as  in  the  case  of  tissue-food,  the 
weight  of  a  young  infant  as  18  lbs.,  and  its  normal  daily 
fuel  supply  at  2  oz.  of  fat  and  4^  oz.  of  starch,  that  is,  in 
terms  of  starch  only,  about  7^  oz.  or  240  grammes  per 
day  (for  both  fat  and  starch  are  not  necessary;  each  of 
them  can,  provided  allowance  be  made  for  the  difference 
in  food  value,  usually  replace  the  other),  we  find  the  de- 
mand, roughly  speaking,  to  be  3^  drachms,  avoirdupois, 
of  starch  per  day,  per  pound.  Taking  also  the  weight  of 
an  old  man  at  154  lbs.,  and  his  physiological  daily  needs 
at  22  oz.  of  starch  and  4  of  fat,  which,  rendered  in  terms 
of  starch  food  only,  means  approximately  29  oz.  or  928 
grammes,  and  let  this  be  divided  by  154,  the  number  of 
pounds,  and  we  have  per  pound,  per  day,  a  demand  in  old 
age  of  1^  drachm  avoirdupois.f 

age  fatness  and  include  their  adipose  tissue.  Nevertheless,  inas- 
much as  fat  is  not,  and  never  has  been,  of  the  nature  of  living,  food- 
demanding  cell-tissue,  all  excesses  of  fat  above  the  average  must 
be  deducted  even  in  this  calculation.  In  women  over  thirty,  and 
sometimes,  but  more  rarely,  in  men,  this  extra  fat  may  constitute 
one  sixth  or  more  of  the  total  bodily  weight. 

*  Some  authorities  put  the  proportions  at  25  to  10. 

f  The  table  from  which  I  have  made  my  calculation  is  one 
founded  on  the  mean  of  the  several  tables  of  the  eminent  authori- 
ties Drs.  Parkcs,  Davy,  Playfair,  Von  Pettenkofer,  and  Von  Voit, 
and  quoted  on  page  259  in  my  book  "  The  Demon  of  Dj^spepsia."   I 


THE  FOOD  DEMANDS  OF  THE  BODY.        151 

If  starch  be  rendered  in  terms  of  fat,  the  result  will,  of 
course,  for  infancy  and  old  age,  remain,  relatively,  the 
same. 

Old  age  requires,  then,  about  half  the  amount  of  both 
albumen  and  of  fuel-food,  per  unit  of  weight,  as  compared 
with  the  commencement  of  life. 

IV.  The  daily  demand  for  fuel-food  varies,  however, 
from  causes  which  have  little  or  no  effect  upon  the  ques- 
tion of  tissue-foods.  The  following  conditions  render 
necessary,  within  certain  limits  fixed  by  the  powers  of 
digestion,  an  increased  supply. 

(a)  Great  exertion.  For  fuel-food  supplies  the  motor 
power  of  the  body. 

(b)  A  cold  state  of  the  atmosphere,  for  fuel-food  being 
the  source  of  bodily  heat,  it  is  clear  that  the  greater  the 
loss  of  the  latter  by  radiation,  the  larger  must  be  the  sup- 
ply of  fuel-food  to  keep  up  the  necessary  temperature  of 
the  tissues. 

(c)  A  moist  state  of  the  air  which  favors  the  loss  of 
heat  by  the  body. 

(d)  Deficient  or  unsuitable  clothing.  Flannel,  silken, 
and  woollen  materials  in  general  are  bad  conductors  of 
heat,  and  have,  as  we  all  know  by  experience,  a  very  pow- 
erful influence  in  preventing  an  undue  loss  of  caloric,  and 
therefore  act  as  economizers  of  fuel-food,  while  cotton, 
linen,  and  flaxen  clothing  materials  have  an  opposite  char- 
acter and  effect. 

We  possess  no  sufficient  data  upon  which  may  be  based 
rules  applicable  to  the  daily  physiological  needs  in  the  salt 
and  water  supply  of  the  body,  and  though  death  invariably 
ensues,  within  the  course  of  a  few  days,  when  either  or 

have  not  aimed  at  strict  mathematical  accuracy,  as  the  public  do  not 
take  kindly  to  decimals;  nevertheless  the  calculation  is  suflSciently 
close  to  prove  the  rule  laid  down. 


152  DISEASES    DUE    TO    DEFICIENCY    OF    FOOD. 

both  of  these  ingredients  is  withheld,  yet  there  exists  no 
single  classified  disease,  not  even  excepting  scurvy,  which, 
as  far  as  we  know,  can  be  said  truthfully  to  depend  solely 
on  an  habitual  lack  of  either  of  these  essentials.  The 
bodily  instinct  in  the  case  of  the  consumption  of  w^ater 
and  common  salt  (as  in  that  of  other  foods)  is  so  strong, 
and  the  means  of  gratifying  it  so  ready  to  the  hand,  that 
it  is  perhaps  difficult  to  conceive  any  common  disease 
that  can  have  as  sole  cause  and  origin  a  want  of  either 
salt  or  water;  but  in  regard  to  other  salts — also  essentials 
in  food,  though  only  in  minute  quantities  —  such  as  the 
chlorides  of  potassium,  magnesium,  and  ammonium,  and 
the  various  alkaline  phosphates,  carbonates,  and  sulphates, 
found  more  commonly  in  the  vegetable  than  in  the  animal 
world,  and  largely  lost  in  the  act  of  cooking,  it  is  evident 
that  a  lack  of  them  is,  while  still  not  the  sole,  at  least  the 
main,  factor  in  many  well-understood  derangements  of  the 
bodily  mechanism,  to  which  I  shall  presently  draw  attention. 


CHAPTER  VIII. 

DISEASES  DUE  TO  EXCESS  OF  FOOD. 


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Motor  system. 


Reproductive  system. 


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Nervotts  system. 


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Treatment. 


Acute  Dyspepsia 

(Acute  Gastric 

Catarrh). 


Chronic  Dyspepsia. 


Gout. 


Biliousness. 


Rheumatism 
(Chronic). 


Glucosuria 

(Functional 

Diabetes). 

Gall-stone. 
Corpulence. 


Discontinue  nearly  all  feeding  for  a  day  or 
two,  then  gradually  and  cautiously  return 
to  a  normal  dietarj^     Let  the  patient  rest. 
Empty  the  stomach  and  bowels  by  a  purga- 
tive; then  soothe  them  by  poulticing  and 
by  administering,  if  necessary,  bismuth. 
Cut  the  food  down  in  amount  and  quality  so 
as  to  suit  the  bodily  needs.     Avoid,  as  a 
rule,  all  alcoholic  stimulant.     Enjoin  exer- 
cise in  the  open  air.    Remove  all  conditions 
unfavorable  to  the  general  health  of  the 
body.    Give  no  drugs,  or  only  an  occasional 
purge. 
Order  the  minimum  of  necessary  food,  but 
allow  an  abundance  of  water.     Exercise 
freely.      Frequent    hot    bathing.      Warm 
clothing.     Avoidance  of  worry  and  all  de- 
pressing agents.    Bowels  to  be  kept  regu- 
lar.    Dry  climate. 
Acute  gout  to  be  treated  by  rest,  application 
of  warmth  to  inflamed  parts,  very  restricted 
dietary  and  smart  purgation. 
{  Simplify  the  dietary,  enjoin  abundant  exer- 
I      cise,  and  keep  the  bowels  regular. 
A  minimum  of  necessary  food.     Abundant 
(not  excessive)  exercise.     Warm  clothing. 
A  dry  climate.    Frequent  bathing,  followed 
by  prolonged  friction  of  muscles. 
Acute  rheumatism,  treated  like  the  fevers. 
(  Lessen   amount   of    starchy   and   saccharine 
J      articles  of  food.    Exercise.     Improve  gen- 
(      eral  health. 

Simple  diet.     Rest.     Surgical  measures. 
(  Exercise.    Take  little  fluid  with  food.    Avoid 
J      fattening  articles.      Reduce   diet   scale  to 
(      minimum  necessarJ^ 


Ube    ffOOC)    ^>S5tCm—(contimfed). 


CHAPTER  VIII. 
DISEASES    DUE    TO  FOOD. 

(b)  to  excess  of  food. 

In  our  last  chapter  we  briefly  discussed  the  conse- 
quences that  must,  and  do  actually,  ensue  when  the  body 
of  man  is  deprived  of  food,  the  sole  source  from  whence  he 
can  draw  life  and  movement.  We  also  observed  that 
a  due  supply  of  food  could  not  alone  rectify  the  symptoms 
of  deprivation,  but  that  an  efficient  intake  of  oxygen  to 
extract,  by  consuming,  the  energies  from  this  food  must 
also  be  provided  for;  and  that,  finally,  a  removal  of  the 
waste  material  clogging  the  blood  and  lymph  channels, 
and  thus  obstructing  the  due  passage  to  the  cells  of  the 
food  consumed,  is  the  third  and  last  essential  in  the  cure 
of  slow  or  rapid  starvation  of  these  cells,  and  the  starva- 
tion of  his  cells  is  the  starvation  of  the  man. 

Food,  normal  in  quality  and  amount,  pure  air  and  mus- 
cular exercise,  were  thus,  we  rightly  concluded,  the  three 
concurrent  means  to  be  employed  for  the  cure  of  a  deficien- 
cy in  the  food  supply. 

But  many  and  grave  as  are  the  bodily  derangements 
that  ensue  in  cases  where  the  consumption  of  food  falls  be- 


156  DISEASES    DUE    TO    EXCESS    OF   FOOD. 

low  the  necessary  level,  they,  by  comparison  with  those 
that  are  due  to  the  opposite  condition,  that  of  habitual 
excess,  become  almost  insignificant.  And  excess,  like  de- 
privation, may  be  of  two  very  distinct  kinds.  We  may 
have,  on  the  one  hand,  a  group  of  striking  symptoms,  the 
importance  of  which  we  are  forced  to  recognize,  and  the 
discomfort  of  which  compels  the  glutton  to  be  cautious, 
to  which  we  shall  give  the  name  of  Acute  Dyspepsia,  all 
the  rapid  and  evident  sequence  of  a  sudden  or  gross  act 
of  gluttony,  an  intake  of  food  disproportioned  to  the 
powers  of  the  digestive  organs  ;  or,  on  the  other  hand,  we 
may  witness,  as  the  result  of  habitual  but  slight  excess,  a 
series  of  comparatively  trivial,  but  gradually  increasing, 
discomforts,  some  of  which  are  felt  in  the  abdominal  re- 
gions, while  others  have  apparently  no  connection  what- 
ever with  a  failure  of  the  digestive  powers,  and  may  only 
be  tracked  to  their  origin  by  steadily  keeping  in  mind  the 
great  physiological  truth  that  digestion  is  the  one  great 
process  of  life,  and  that  it  is  not  confined  to  the  mouth, 
stomach,  and  intestines,  but  continues  in  the  onward  pas- 
sage of  the  food,  after  it  has  left  those  organs,  and  until  it 
reaches  its  final  destination  in  the  body.* 

Let  us  first,  then,  study  the  effects  of  sudden  gross  ex- 
cess of  food,  which  induces  that  train  of  painful  symptoms 
spoken  of  collectively  as  Acute  Dyspepsia,  and  in  medical 
books  as  Acute  Gastric  Catarrh,  both  of  which  terms  are 
im^^erfect,  the  first  implying  too  much,  the  second  too  lit- 
tle.   We  shall  here  adopt  the  former  of  these  designations. 

*  Digestion  is  a  series  of  simple  changes  by  which  the  three  va- 
rieties of  food,  in  chemical  language  called  the  albumens  (tissue- 
foods),  the  hydro-carbons  (fats),  and  the  carbo-hydrates  (sugars  and 
starches),  are  from  the  time  of  their  entering  the  mouth  till  they  leave 
the  body  by  the  kidneys,  skin,  lungs,  etc.,  alternately  changed  from 
colloids  to  crystalloids,  and  mce  versa;  salt  and  water  undergoing  no 
change,  but,  as  solvents  of  the  others,  remaining  always  crystalloid. 


SYMPTOMS    OF   ACUTE   DYSPEPSIA.  151? 

The  causes  of  acute  indigestion  are  found  in  a  consump- 
tion of  food,  in  quantity  or  in  quality,  in  excess  of  the  di- 
gestive powers  of  an  individual. 

The  amount  and  kind  of  food  necessary  to  set  up  these 
symptoms  will  vary,  as  will  the  severity  of  the  symptoms 
themselves,  with  the  age  and  the  previous  state  of  health, 
the  suddenness  of  the  excess,  and  with  other  conditions. 
I  will  give  a  sketch  of  a  typical  case,  and  will  suppose  that 
the  food  which  has  set  it  up  is  an  admixture  of  albumen, 
fat,  starch,  and  sugar.  The  following  is  the  order  of  the 
phenomena. 

In  the  mouth,  there  is  at  first  no  derangement,  but  after 
the  stomach  has  become  disordered,  it,  through  its  intricate 
nerve  connection  with  the  latter  organ,  participates  in  the 
disorder,  the  tongue  becoming  furred,  the  saliva  sticJcy, 
lacking  in  digestive  power  and  sometimes  even  acid  in 
reaction,  and  tJie  taste  vitiated. 

In  the  stomach,  over-distension  leads  to  partial  loss  of 
power;  the  food  is  therefore  neither  properly  rolled  over, 
so  that  each  part  may  be  presented  to  the  digestive  fluid, 
nor  is  it  duly  moved  on  towards  the  outlet  into  the  bowel. 
As  a  YQS\Ai,fermentatio7i  sets  in,  and  irritating  acids  and 
gases  are  given  off  by  it.  The  patient  complains  therefore 
of  pain,  iceight,  diste?ision,  acidity,  and  fatulence  in  that 
region. 

In  the  howel.  Slowly  this  acid,  fermenting  mass  reaches 
the  bowel,  but  neither  the  digestive  fluids  of  the  j^ancreas 
nor  those  of  the  bile  can  exert  their  power  over  it,  for 
they  are  only  effective  in  an  alkaline  medium.  On  there- 
fore along  the  many  feet  of  bowel  rolls  the  food,  its 
acid  state  irritating  the  lining  membranes  and  setting  up 
griping  pain  or  colic,  its  gas  distending  the  coils  of  bowel 
and  thus  producing  further  discomfort.  Eventually  it 
is  expelled  the  body,  acid,  full  of  gas,  and  mixed   with 


158  DISEASES    DUE    TO    EXCESS    OF    FOOD. 

water  drawn  by  the  irritation  from  the  walls  of  the  in- 
testine. 

In  the  other  parts  of  the  body.  Such  a  state  of  matters 
as  I  have  sketched  must  affect  in  some  measure  every 
bodily  organ,  for,  independently  of  the  general  reaction 
set  up  by  the  gastric  and  intestinal  disturbance,  other  ef- 
fects of  a  disturbing  nature  are  witnessed  in  the  most 
distant  parts  of  the  body  as  a  result  of  some  slight  absorp- 
tion into  the  blood  of  the  acids  and  other  crystalloid  prod- 
ucts of  decomposition.  The  patient  will,  as  a  result  of 
the  latter,  experience  headache,  vertigo,  rheumatic  pains, 
depressio7i  of  S2nrits,  and  possibly  a  little  jaundice  and 
other  discomforts. 

But  there  is  one  variety  of  acute  indigestion  in  which, 
though  the  symptoms  are  identical  to,  the  causation  is  a 
little  different  from,  the  one  just  drawn. 

In  any  and  every  form  of  blood  derangement,  whether 
the  contamination  be  due  to  some  improper  nourishment 
or  be  the  secondary  consequence  of  some  general  and  se- 
vere disorder,  the  stomach  may  be  selected  as  the  seat  of 
one  of  the  crises  by  which  the  course  of  those  disorders  is 
marked,  as  least  for  as  long  as  the  body  of  the  sufferer  re- 
tains a  fair  amount  of  vigor.  Thus  in  gout,  rheumatism, 
lead  poisoning,  and  chronic  biliousness,  all  at  once,  with- 
out warning  or  apparent  cause,  acute  indigestion  may 
come  on  and  render  the  patient  miserable  for  days,  while 
in  progressive  pernicious  anaemia,  in  locomotor  ataxia,  and 
in  other  nervous  diseases,  the  same  phenomenon  is  so  com- 
mon as  to  form  a  distinctive  feature  in  making  a  diagnosis. 
In  the  early  stages  of  most  fevers,  before  yet  the  cells 
have  been  so  poisoned  as  to  lose  their  power  of  rebellion, 
a  similar  state  of  matters  is  also,  as  most  of  us  know,  to 
be  witnessed. 

In  every  case  acute  indigestion  is  a  markedly  beneficial 


TKEATMENT    OF    ACUTE    INDIGESTION.  159 

process,  ridding  the  body  of  poison,  or  of  excess,  as  the 
case  may  be. 

Treatmeyit  of  acute  indigestion.  The  line  of  treatment 
is  a  close  copy  of  I^ature's  own  processes. 

The  first  of  Nature's  symptoms,  and  the  one  to  avoid 
complicating  the  picture,  to  which  I  have  not  as  yet  re- 
ferred, is  sickness.  The  gastric  disturbance  naturally 
produces  this— /auor  it  by  taking,  in  the  early  stages, 
and  while  the  stomach  is  still  loaded,  mild  emetics.  Hot 
Avater,  or  hot  water  and  salt,  will  generally  suffice.  If 
acidity  still  persist, /"a vw  it  by  drinking  every  hour  or 
two  a  tablespoonful  of  lemon-juice,  or  twenty  drops  of 
diluted  sulphuric  acid,  in  a  wineglassf  ul  of  water.  If  some 
of  the  fermenting  food  has  reached  the  bowel,  favor  its 
expulsion  from  the  body  by  a  quick  and  mild  aperient — 
castor  oil  is  the  best.  There  is  loss  of  appetite,  take  no 
food;  there  is  thirst,  take  plenty  of  water,  or  other  bland 
fluid,  such  as  barley  or  rice  water,  that  cannot  aid  fer- 
mentation. There  is  disinclination  for  work,  noise,  or 
light — rest  in  a  quiet,  darkened  room. 

If,  after  these  measures  have  been  taken,  irritability  of 
the  stomach,  nausea,  etc.,  still  persist,  take  what  Dr.  Lau- 
der Brunton  ("Pharmacology,"  1885,  p.  318)  calls  a  mild 
stomachic  irritant — trisnitrate  of  bismuth.  This  drug  is 
perfectly  innocuous,  its  action  being  almost  purely  a  me- 
chanical one.  As  much  as  will  lie  on  a  shilling  may  be 
taken  every  one,  two,  or  three  hours,  according  to  the 
persistence  of  symptoms,  in  a  wineglass  of  freshly  drawn 
soda  water  or  in  thick  barley  water. 

Should  some  gastric  and  abdominal  pain  nevertheless  per- 
sist, compel  the  skin  to  share  in  the  burden  of  the  dis- 
order by  congesting  it  mildly,  which  can  be  done  by  ap- 
plying hot  poultices,  in  rapid  succession,  to  the  abdomen, 
or  a  mustard-plaster  over  the  pit  of  the  stomach. 


160  DISEASES    DUE   TO    EXCESS    OF    FOOD. 

As  a  guide  to  the  dietary  of  the  patient  the  desires  of 
the  sufferer  will  be  the  best  guide,  and  he  will  generally, 
and  very  wisely,  decline  all  food  for  the  first  twenty-four 
hours.  The  return  to  a  full  dietary  must  be  very  gradual 
and  extended  over  some  days. 

Such  is  acute  dyspepsia,  and  such  its  satisfactory,  its 
rational  treatment.  Let  us  now  turn  to  the  consequences 
of  habitual,  but  perhaps  only  comparatively  slight,  excess 
— not  generally  recognized  by  the  patient  as  excess  at 
all — and  trace  the  fnany  consequences  thereof. 

Once  more  we  will,  in  spirit,  follow  the  food  through 
the  digestive  organs  and  channels,  and  trace  successively 
in  the  mouth,  stomach,  and  bowels  the  series  of  derange- 
ments, varying  somewhat  in  every  individual,  and  collec- 
tively known  as  Chronic  Dyspepsia. 

In  the  mouth  we  very  plainly  see  in  loss,  decay,  and 
discoloration  of  teeth,  or  in  much  dental  patchwork,  evi- 
dences of  the  mischief  wrought.  The  tongue  is  abnormal 
in  appearance:  it  may  be  bright  red,  a  condition  due  to  a 
transient  gastric  irritability  reflected  by  the  agency  of  the 
nerve  mechanism  on  the  tongue,  but  more  commonly  it 
is  slightly  furred^  soft^  and  indented  at  the  edges  by  the 
teeth. 

In  the  stomach  there  will  be  present  a  marked  loss  of 
muscular  tone,  a  pale  grayish  appearance  of  the  organ 
contrasting  markedly  with  the  rose-pink  hue  of  health, 
and  much  mucus.  The  patient  will  inform  you  that  he 
can  still  digest  plain  and  restricted  meals,  such  as  are  com- 
posed of  meat,  bread,  green  vegetables,  and  fruit  only,  or 
of  coffee  and  bread  with  butter,  or  bread  and  cheese  taken 
alone,  or  a  milk  pudding,  but  that  he  experiences  discom- 
fort after  mixed  and  large  meals,  and  that  sweet  wines 
(great  favorers  of  gastric  fermentation)  act  as  poisons 
with  him. 


SYMPTOMS    OF    CHRONIC    DYSPEPSIA.  161 

In  the  bowels  the  same  loss  of  tone  is  evident,  and  as 
a  result  we  hear  complaints  of  constipation,  of  obstinate 
collections  of  wind  in  dilated  coils  of  intestines,  and  of 
occasional  attacks  of  diarrhoea  from  food  that  has  lain 
too  long  in  the  intestine  and  has  become  intensely  acid. 

In  the  liver  we  witness  such  important  signs  of  break- 
down that  we  shall  consider  them  separately.* 

But  let  us  indicate  the  general  line  of  treatment  of 
chronic  indigestion  before  we  discuss  the  j'esults,  as  seen 
in  the  liver,  of  excess. 

First  of  all,  limit  the  food-supply  to  the  digestive 
powers.  Order  small,  simple  meals  of  plain,  well-cooked, 
and  digestible  foods,  selecting,  however,  wisely  those  that 
contain  a  large  quantity  of  unassimilable  material — such 
are  to  be  found  in  brown  bread,  the  various  porrid^^-es, 
fruits,  vegetables,  etc. — all  of  which  will  assist  a  regular 
evacuation  of  the  abdominal  contents.  Discountenance 
large  mixed  meals,  and  also,  in  most  cases,  the  drinking  of 
alcoholic  stimulants.  Convince  the  patient  by  reference  to 
even  the  most  liberal  of  diet-tables  that  he  has  been  con- 
suming for  a  long  time  much  more  food  than  his  body 
actually  requires. 
^  In  obstinate  cases,  especially  in  those  where  a  suspicion 
of  gout  is  found,  it  is  well  to  order  a  gradual  approach  to 
a  strictly  vegetarian  dietary,  allowing  meat  but  once  a 
day,  and  in  time  discontinuing  even  this. 

Secondly,  order  reasonable  amount  of  exercise  in  pure 
air,  so  that  on  the  one  hand  the  muscles  may  rid  them- 
selves of  waste,  and  on  the  other  the  lungs  may  draw  in  an 
abundance  of  oxygen  to  consume  the  foods. 

*  Chronic  indigestion  is  not  always  due  alone  to  a  mere  excess  of 
food  over  the  digestive  powers,  for  these  latter  may  be  enfeebled  by 
bad  air,  by  overwork,  by  worry,  by  inherited  taint,  etc.,  and  thus  be 
factors  in  its  causation. 


162  DISEASES    DUE   TO    EXCESS    OF   FOOD. 

Thirdly^  seek  to  remove  conditions  unfavorable  to  the 
general  health —worry,  bad  air,  close  sleeping- apartments, 
presence  in  the  blood  of  any  poison. 

Lastly,  give,  if  necessary,  from  time  to  time,  a  simple 
purgative  to  aid  matters.  A  combination  of  bismuth,  bi- 
carbonate of  soda,  and  rhubarb  answers  well.  (Form.  1, 
Appendix.) 

Disturbances  of  the  Liver,  the  result  of  cm  excess  in  the 
food  supply  over  the  bodily  needs. — The  liver  has  four 
great  functions  : 

1.  It  converts  a  portion  of  the  albumen  it  receives  to 

urea,  etc. 

2.  It  converts  a  portion  of  the  albumen  it  receives  to 

bile  acids. 

3.  It  converts  a  portion  of  the  albumen  it  receives  to 

serum  albumen. 

4.  It  stores,  as  glycogen,  the  carbo-hydrate  fuel-foods. 

5.  It  acts  as  an  excretory  organ. 

Now,  overwork  of  the  liver  means,  sooner  or  later,  a 
breakdown  of  its  functions,  the  advent  of  failure  being 
hastened  by  the  influences  of  heredity  or  of  any  other 
cause,  such  as  mental  anxiety,  which  exercises  a  debili- 
tating influence  on  the  liver  in  common  with  the  whole 
body,  or  by  the  presence  of  poisons,  especially  of  lead,  in 
the  blood-current,  and  these  facts  require  to  be  carefully 
stored  in  the  reader's  memory,  for  though  the  sole  real 
and  ultimate  causation  of  the  special  poisons  of  three  of 
the  complaints — viz..  Gout,  Biliousness,  and  Rheumatism — 
which  we  are  about  to  consider,  must  lie  in  the  faulty 
digestion  of  albumen,  for  their  chemical  composition 
shows  that  no  other  origin  is  possible,  yet  the  proximate 
cause,  that  last  straw  whose  weight  brings  out  the  dis- 
order, is  often  to  be  traced  to  lead-poisoning,  to  heredity, 
to  mental  worry,  etc.,  often  so  prominent,  while  the  real 


THE    GENESIS    OP    GOUT.  163 

cause  is  so  obscure  as  to  delude  the  observer  and  lead  to 
altosrether  false  ideas  as  to  the  actual  relations  in  the  dis- 
order  between  cause  and  effect,  and  this  mistake  may  lead 
to  a  wrong  line  of  treatment,  and  thus  to  serious  disaster. 

Let  us  view,  in  the  order  in  which  I  have  placed  the 
liver  functions  themselves,  the  symptoms  attendant  on 
their  breakdown. 

1.  The  liver  fails  to  convert,  in  fact  to  oxidize,  com- 
pletely one  portion  of  albumen,  and  therefore,  in  lieu  of 
urea,  throws  on  the  circulation  a  less  oxidized  substance, 
uric  acid. 

Uric  acid,  on  entering  the  circulation,  deprives  the  blood - 
current  of  many  alkaline  constituents  by  uniting  with 
them,  and  thus  forming  various  urates,  of  which  urate  of 
sodium  is  the  most  important. 

It  has  a  further  effect  attended  with  wide-reaching  re- 
sults. Uric  acid  and  urate  of  sodium  are  very  insoluble, 
requiring,  according  to  temperature,  twelve  to  fifteen  thou- 
sand times  their  weight  of  water  (!)  for  solution;  urea  is 
soluble  in  its  own  weight. 

Let  us  see  what  must  follow  from  an  habitual  produc- 
tion in  excess  of  uric  acid  by  the  liver. 

If  the  kidneys  be  very  active,  and  the  supply  of  water 
in  the  blood  abundant,  the  subject  of  liver  breakdown  will 
pass  urates  and  uric  acid  in  large  quantities  ;  these  may 
take  the  form  of  a  colored  (usually  red)  deposit  in  the 
urine,  in  worse  cases  that  of  Gravel  or  even  of  Stone. 

But,  it  being  supposed  that  overwork  of  the  liver  con- 
tinues, and  that  mental  worry  or  other  proximate  cause 
co-exists,  a  time  will  come  when  the  hardly  driven  kidneys 
will,  of  necessity,  begin  to  fail. 

When  that  occurs,  the  uric  acid,  etc.,  will  commence  to 
accumulate  in  the  blood,  and,  being  very  insoluble,  will 
before  long  crystallize  out  in  places  where  the  circulation 


1G4  DISEASES    DUE    TO    EXCESS    OF    FOOD. 

is  slowest  and  least  active.  It  selects  thus  the  old  scars 
of  wounds,  the  joint  of  the  large  toe  in  civilized  tight- 
boot-wearing  man,  the  inside  of  the  knee  in  great  riders, 
etc.  This  crystalline  deposit  sets  up  inflammation,  and 
an  acute  attack  of  Gout  occurs. 

Very  often,  however,  the  various  factors  in  gout  do  not 
tread  so  rapidly  on  each  other's  heels.  The  excess  of  food 
is  slight,  the  liver  breakdown  but  partial,  entailing  a  loss 
of  appetite  that  turns  the  patient  against  food,  and  thus 
retards  the  course  of  matters,  and  the  kidneys  are  fairly 
active.  ISTevertheless,  gout  poison  is  all  the  time  in  the 
blood,  setting  up  a  long  list  of  derangements,  of  which 
acidity  y  depression  of  spirits^  vertigo^  epileptiform  fits,  ting- 
ling and  nwnhness  of  the  extremities,  eczema,  palpitation, 
neuralgia,  flying  pains,  headaches,  disturbances  of  sight 
and  hearing,  etc.,  etc.,  are  the  commonest  outward  evi- 
dences. This  constitutes  latent  Gout  or  chronic  Gout,  which 
may  extend,  often  unsuspected,  and  without  the  produc- 
tion of  a  single  acute  attack,  over  a  score  of  years. 

There  is  no  disease  that  latent  gout  may  not  simulate; 
fortunately  the  proofs  of  its  existence  are  always  obtain- 
able from  a  careful  analysis  of  the  blood  serum  or  of  the 
urine. 

In  the  course  of  prolonged  states  of  gout  such  as  I  have 
referred  to,  deposits  of  urate  of  sodium  (the  so-called  Chalk 
Stones)  often  appear  on  the  joints  of  the  fingers,  the  lobes 
of  the  ear,  or  the  valves  of  the  heart. 

The  prolonged  irritation  of  the  kidneys  by  uric  acid, 
etc.,  is  one  of  the  great  causes  of  the  appearance  of  con- 
tracted kidney,  a  fatal  degeneration  better  known  as  the 
Gouty  Kidney  of  Bright,  the  commonest  form  of  Slight's 
Disease.  This  failure  of  the  kidneys  is  accompanied  by  a 
similar  degeneration  of  the  blood-vessels,  and,  to  some  ex- 
tent, also  of  the  heart.     Gout  is  thus  reckoned  as  one  of 


THE    GENESIS    OF    GOUT.  165 

the  causes  of  Heart  Disease  and  of  Calcification  of  the  Ar- 
teries, and  lience  of  rupture  of  a  blood-vessel  in  the  brain 
or  Apoplexy. 

To  sum  up  :  Gout  consists  in  a  peculiar  inflammation  of 
the  joints  and  fibrous  tissues  associated  often  with  deposi- 
tions of  urate  of  sodium  (chalk  stones). 

It  is  characterized,  in  the  acute  stage,  by  inflammation 
of  a  joint  or  joints,  attended  with  great  pain,  swelling, 
and  fever j  in  the  chronic  stage  by  long-continued  ill- 
health  marked  often  by  skin  disease,  nervous  and  gastric 
disorders,  the  occasional  ^:>a55??2/7  of  sand  or  gravel,  or  by 
some  one  or  more  of  innumerable  symptoms,  many  of 
which  may  simulate  very  closely  those  of  some  graver 
disorder.  This  stage  may  last  many  years,  and  its  exis- 
tence is  often  indicated  by  distortion  of  the  joints,  espe- 
cially of  the  smaller  ones,  the  result  of  the  deposit  of  the 
urates.* 

The  poison  of  gout  is  always  the  result  of  mal-digestion 
of  albumen;  its  formation  is  favored  by  hereditary  weak- 
ness of  the  liver,  and  by  every  other  debilitating  cause. 

The  acute  attacks,  being  beneficial  processes  of  Xature, 
end  in  the  more  or  less  complete  removal  of  the  poison; 
the  chronic  attacks  lead  to  skin  affections,  gastric  disturb- 
ances, etc.,  etc.,  and  often  cause  death  by  inducing  degen- 
eration of  the  kidneys,  blood-vessels,  and  heart,  the  ad- 
vancing failures  of  which  aggravate  the  gout,  and  them- 
selves lead  to  a  long  list  of  secondary  disasters. 

*  At  this  point  tlie  author  must  seek  to  disarm  the  hj^percritical 
by  explaining  that  he  follows  the  teaching  of  Bouchard  in  this 
treatise,  while  being  well  aware  that  very  many  theories,  which  re- 
duce the  part  plaj^ed  b}''  the  liver  in  the  production  of  gout,  are 
existent  and  find  influential  support.  All  theories,  moreover,  agree 
in  the  identity  of  ^iric  acid  as  the  gout  poison,  all  acknowledge  a 
partial  breakdown  of  the  liver  as  a  main,  though  not  the  sole,  cause. 


166  DISEASES    DUE    TO    EXCESS    OF    FOOD. 

The  treatment  of  gout,  the  next  point  that  demands  our 
attention,  will  not  present  any  difficulties. 

That  of  the  chronic  stage  is  safely  and  satisfactorily 
conducted  on  the  following  lines  : 

[a)  Cut  down  the  daily  supply  of  albumen  to  as  low  a 
limit  as  is  consistent  with  the  maintenance  of  health.  This 
may  be  done  by  several  methods.  To  order  a  vegetarian 
dietary  is  the  simplest  and  most  effectual  way,*  but  a  sud- 
den transition  from  a  full  meat  dietary  to  a  strictly  vege- 
tarian one  is  not  always,  except  in  the  very  robust,  an  ab- 
solutely safe  procedure,  and  even  then  it  requires  some 
fortitude  on  the  part  of  the  patient  to  face  it,  especially 
durins:  the  first  two  or  three  months.  To  restrict  meat  to 
one  meal  a  day,  and  to  limit  the  selection  to  poultry,  game, 
rabbit,  or  fish,  will  often  suffice  in  mild  cases  of  gravel, 
gouty  neuralgia,  etc.  Free  purgation,  by  constantly  sweep- 
ing from  the  intestine  much  food  that  w^ould  otherwise  be 
absorbed,  acts  well  mainly  by  cutting  down  the  dietar^^, 
and  to  send  the  patient  to  a  purgative  mineral  spa  effects 
the  sam«  end  by  the  same  means. 

Whichever  of  the  above  courses  be  preferred,  the  fol- 
lowing dietetic  rules  are  applicable  in  every  case.  Eat 
plenty  of  fruit.  Avoid  a  large  admixture  at  one  meal  of 
different  substances  ;  if  meat  be  consumed,  let  it  be  eaten 
with  bread  or  green  vegetables  and  followed  by  fruit 
only;  if  milk  puddings  be  desired,  take  them  alone  or 
with  a  little  fruit.  Breakfast  should  be  the  ow\y  full  meal; 
all  others  must  be  restricted  in  amount.  Avoid  sweet 
wines  or  malt  liquors,  especially  at  meals  in  which  meat  is 


*  In  adopting  the  vcgetariau  regime  the  patient  should  obtain  all 
necessary  directions  as  to  the  cooking  and  the  varieties  of  the  neces- 
sary food  from  the  Secretary  of  the  Vegetarian  Society,  75  Princess 
Street,  Manchester,  Eng.,  or  from  some  other  competent  authority. 


THE    TKEATMENT    OF    GOUT.  167 

an  ingredient.  Tea,  coffee,  and  cocoatine  are  allowable,  as 
is  sometimes  whiskey  or  white  natural  wine,  largely  dihited. 
In  fine,  great  moderation  in  food  is  the  first  aim  in  the 
cure  of  gout,  and  simplification  of  the  meals  is  a  powerful 
adjunct  thereto. 

(b)  Exercise  in  pure  air  should,  according  to  the  pa- 
tient's strength,  be  indulged  in,  for  muscular  movemeut 
pumps  the  waste  nitrogenous  material  from  the  tissues 
and  leads  to  a  greater  intake  of  oxygen  and  a  more  per- 
fect combustion  of  the  foods. 

(c)  The  next  aim  is  to  rid  the  blood  of  the  uric  acid. 
This  is  best  accomplished  by  the  simple  method  of  drink- 
ing one  or  two  quarts  of  hot  water  every  day.  It  is  some- 
times advisable,  especially  in  advanced  cases,  w^here  the 
blood  has  been  largely  robbed  of  its  alkaline  salts,  to  sup- 
plement this  treatment  by  a  daily  small  dose  of  some  one 
of  the  alkaline  mineral  waters,  as  those  of  Carlsbad, Vichy, 
Contrexeville,  Kronenquelle,  etc. 

(d)  Bathing  is  useful.  A  daily  cold  bath  is  often  of 
service  in  rousing  the  nervous  system,  and  a  bi-weekly 
hot  bath,  or  a  weekly  Turkish  bath,  in  maintaining  a  prop- 
erly pervious  state  of  the  skin. 

(e)  Climate  and  soil  must  next  be  looked  to.  A  dry  soil 
is  essential  to  the  cure  of  all  cases  of  chronic  gout,  while, 
if  the  patient  can  afford  it,  he  will  do  well  to  spend  the 
winter  and  spring  in  a  drier  and  warmer  climate  than  is 
to  be  found  anywhere  in  Great  Britain. 

(/)  Finally,  all  conditions  antagonistic  to  general  bodily 
vigor,  such  as  worry,  anxiety,  overwork,  over-fatigue,  great 
mental  excitement,  the  atmosphere  of  gas-laden  rooms, 
the  contact  with  damp,  residence  on  clay  soils — in  short, 
evervthinfy  that  our  common-sense  tells  us  tends  to  de- 
press  the  bodily  functions  must,  as  far  as  possible,  be 
shunned. 


168  DISEASES   DUE   TO   EXCESS    OF    FOOD. 

The  application  of  the  above  measures  will  vary  in  each 
case.  Often  it  is  best,  to  secure  all  the  desirable  ends  at 
one  stroke,  to  send  the  patient  away  to  a  mineral  spring. 
This  will  suffice  to  insure  a  restricted  dietary,  necessary 
exercise,  freedom  from  worry,  bathing,  and  a  full  supply 
of  an  alkaline  fluid  to  the  tissues.  In  many  slight  cases 
a  mere  reform  in  the  dietary  will  suffice,  a  considerable 
reduction  in  the  dail}^  consumption  of  meat;  while  in  oth- 
ers again,  busy  men,  who  are  either  unable  or  unwilling 
to  step  out  of  their  ordinary  routine  for  the  purposes  of 
cure,  it  will  be  necessary  to  order  for  a  time  some  alkaline 
medicine,  free  purgation,  and  frequent  Turkish  baths.  In 
cases  where  gout  is  due  simply  to  debility,  and,  I  repeat, 
these  cases  are  rare,  the  removal  to  a  bracing  climate  and 
judicious  feeding  up  are  the  lines  on  which  treatment 
should  be  based. 

In  the  management  of  acute  gout  the  wise  man  will  view 
with  great  distrust  all  so-called  treatment  that  is  not  built 
on  the  lines  which  Nature  herself  so  plainly  indicates  in 
this  painful  but  health-restoring  process.  There  is  local 
heat  and  congestion,  foster  it  by  the  application  of 
warmth;  there  is  almost  complete  loss  of  appetite,  take 
but'the  smallest  quantity  of  the  simplest  food;  there  is 
thirst,  drink  copiously  of  bland  fluids;  there  is  difficulty 
in  locomotion,  keep  absolutely  quiet.  Ah,  but  there  is 
pain,  says  the  sujfferer.  True;  this  is,  however,  the  conse- 
quence of  a  symptom  (inflammatory  swelling).  It  also 
has  its  use,  and,  unless  it  seriously  impedes  sleep,  is  best 
not  meddled  with,  for  it  will  soon  subside  under  the  course 
of  treatment  recommended. 

I  am  well  aware  that  there  are  many  attacks  of  gout, 
especially  those  which  mark  an  advanced  stage  of  the  com- 
plaint, which  call  for  more  serious  notice.  A  purgative  at 
the  commencement  of  the  attack  is  in  such  cases  advisa- 


THE    TREATMENT    OF    GOUT.  169 

ble,  and  some  stimulation  of  the  kidney  by  small  regu- 
lated doses  of  plain  nitre  or  of  sweet  spirits  of  nitre  is 
often  also  permissible,  though  a  gouty  man,  accustomed  to 
active,  intermeddling  treatment,  will  scarcely  realize  how 
slight,  and  at  the  best  questionable,  is  the  benefit  he  re- 
ceives from  medication.  Morphia  and  colchicum  seem,  to 
those  who  do  not  know  the  complete  results  attendant  on 
their  administration,  to  be  able  to  do  wonders;  but  the 
conscientious  physician,  who  has  the  real  interests  of  his 
patient  at  heart,  will  be  exceedingly  chary  in  having  re- 
course to  these  very  doubtful  friends,  though  when  the 
dangers  from  prolonged  pain  exceed  those  which  usually 
flow  from  the  employ  of  powerful  drugs,  all  scruples  as  to 
the  careful  use  of  the  latter  may  cease. 

Last  of  all,  it  must  not  be  forgotten  that  there  is  a  va- 
riety of  gout,  though  it  is  an  exceedingly  rare  one,  which 
seems  to  be  caused  by  destitution,  by  an  all-round  break- 
ing down  of  the  digestive  and  eliminative  function,  but 
this  is  rather  the  result  of  bad  hyo^ienic  surroundino-s  tlian 
of  want  of  food.  The  cure  lies  in  an  improvement  in  the 
mode  of  life  and  the  administration  of  simple  but  sufti- 
cient  food. 

2.  The  liver  fails  to  supply  in  proper  proportion  bile 
acids  to  the  bowel,  for  the  necessary  result  of  an  excess  in 
the  albumen  supply  is  an  over-production  in  the  bile-acid 
formation.*  This  produces  the  derangement  known  as 
Biliousness,  which,  like  gout,  is  divisible  into  two  well- 
marked  stages,  a  chronic  and  an  acute  (or  curative)  one. 

In  relation  to  the  formation  and  the  course  of  bile,  the 
following  physiological  facts  must  be  noted  : 

(a)  That  bile  consists  of  solids,  mainly  represented  by 

*  Whatever  doubts  may  exist  as  to  the  question  of  the  formation 
of  gout  poison,  there  are  none  as  to  the  fact  here  stated,  that  the 
amount  of  bile  acids  is  increased  by  albuminous  food. 


170  DISEASES    DUE    TO    EXCESS    OF    FOOD. 

bile  acids,  derivatives  of  albuminous  foods,  and  of  liquids 
and  diluents,  represented  by  salts  and  water. 

(b)  That  bile  in  health  travels  slowly,  and  only  at  very 
low  pressure,  along  the  fine  ducts  which  ramify  among 
the  cells,  to  unite  in  the  large  channel  whose  outlet  is  into 
the  bowel. 

What,  then,  must  result  when  the  solids  (the  bile  acids) 
exceed  their  due  proportion  to  the  diluents  ?  Surely  a 
stagnation  or  an  arrest  of  the  bile-current  in  a  greater  or 
less  number  of  the  fine  bile-ducts,  a  consequent  swelling 
of  the  whole  liver  with  a  necessary  imi)airment  of  all  its 
functions,  and  a  defective  flow  ofhile  into  the  bowel.  In 
short,  a  general  state  of  block  in  the  liver.  But  we  must 
go  back  even  further.  A  block  in  the  liver  means  a  slow- 
m<y  of  the  current  in,  and  a  distension  of,  the  portal  vein 
and  its  tributary  branches,  hence  a  partial  arrest  of  the 
powers  of  gastric  and  intestinal  absorption  with  a  result- 
ing decomjyosition  of  food  in  the  boicel,  loss  of  ajyj^etite, 
and,  in  bad  cases,  the  formation  of  piles,  which  are  mere 
bunches  of  distended  varicose  veins.  It  is  unnecessary  to 
add  that  such  a  concatenation  of  evils  is  inconsistent  with 
health;  in  point  of  fact,  we  have  now  reached  a  condition 
of  matters  known  as  latent  or  Chronic  Biliousness,  marked 
by  dyspepsia,  lassitude,  headache,  depression  of  spirits,  and 
all  the  host  of  varying  and  variable  symptoms  dependent 
at  bottom  solely  and  entirely  on  the  blocked  state  of  the 
liver  induced  by  dietetic  excesses. 

Now,  how  will  this  end  ?  Just  in  the  same  manner  that 
the  very  analogous  condition  of  latent  or  chronic  gout 
ended,  in  a  crisis,  an  acute  attack  of  Biliousness.  The  cells 
of  the  body  endure  the  bad,  and  ever  steadily  growing 
worse,  state  of  matters,  till  at  last  the  vomiting  centre  in 
the  brain  becomes  so  irritated  and  stimulated  that,  after 
symptoms  of  severe  headache,  dimness  of  vision,  giddiness, 


THE    TREATMENT    OF    BILIOUSNESS.  171 

etc.,  it  sets  up  violent  and  repeated  retchings^  a  process 
which,  if  sufficiently  prolonged,  effectually  cures  the  whole 
disorder  by  forcibly  squeezing  the  liver  and  compelling  it 
to  disgorge.  That  the  act  of  vomiting  produces  a  very 
powerful  compressing  effect  on  all  the  abdominal  organs 
will  be  readily  understood  by  us,  for  we  know  that,  in  the 
first  instance,  it  suffices  to  forcibly  empty  the  stomach, 
even  to  the  last  few  drops  of  its  liquid  contents,  and,  if 
long  continued,  will  even  evacuate  the  bowel.  But  on  no 
abdominal  organ  does  the  muscular  strain  of  retching  tell 
with  more  force  than  on  the  liver,  for  it,  both  by  its  posi- 
tion in  the  abdominal  cavity,  and  by  its  size  and  solidity 
of  structure,  is,  by  mechanical  laws,  the  organ  that  must 
bear  the  brunt  of  the  compressing  forces,  and  the  result  is 
an  evacuation  of  its  thickened  bile  and  a  copious  discharge 
of  this  into  the  bowel.  This  is  sometimes  even  regurgi- 
tated into  the  stomach,  whence  it  is  vomited;  sometimes 
all  is  forced  onwards  in  the  bowel,  which  is  stimulated  to 
free  action. 

In  acute  gout  and  in  acute  biliousness  we  thus  possess 
two  admirable  pictures  of  the  bodily  methods  of  self- 
cure. 

The  question  of  treatment  will  not  long  detain  us,  for 
that  of  latent  or  chronic  biliousness  is  identical  with  that 
of  latent  gout. 

(«)  The  dietary  is  the  most  important  point.  Rigid 
vegetarianism  rarely  fails  to  permanently  cure,  but  not 
every  one  has  the  physical  strength  and  adaptability  of 
body  necessary  to  face  with  impunity  a  volteface  of  this 
magnitude;  but  the  daily  consumption  of  meat  should  be 
restricted,  and  large  mixed  meals  of  meat,  fat,  starch, 
sugar,  and  alcohol,  must  be  given  up.  Fat  will  agree  well 
with  the  bilious,  starchy  foods  will  also  be  well  digested, 
and  even  albumen  will  give  but  little  trouble  if  they  be 


172  DISEASES    DUE    TO    EXCESS    OF    FOOD. 

not  all  mixed  together  in  the  one  meal.  That  is  the  great 
truth  to  be  borne  in  mind,  not  only  in  biliousness  and  in 
gout,  but  in  every  form  of  chronic  dyspepsia. 

Breakfast  may  be  a  good  meal,  for  the  digestive  powers 
are,  except  in  cases  of  that  chronic  dyspepsia  called  chron- 
ic gastric  catarrh,  which  is  usually  the  result  of  prolonged 
alcoholic  excess,  at  their  best  in  the  morning.  This  meal 
may  consist  of  some  form  of  porridge  and  milk,  bread,  or 
toast,  and  butter,  a  little  fat  bacon  or  even  a  couple  of 
eggs,  and  always,  if  possible,  of  some  fruit.  The  bever- 
age may  be  tea  or  coffee,  hot  water,  or  even  largely  diluted 
white  wine  (Hock,  Moselle,  Claret). 

The  midday  meal  must,  especially  in  the  case  of  busy 
men,  be  very  light.  Bread-and-butter,  followed  by  a  little 
fruit,  and  with  coffee  as  a  beverage,  is  a  good  form  for  it 
to  take. 

Dinner  should  not  be  taken  till  the  labors  of  the  day 
have  been  completed,  and,  if  possible,  forgotten,  and  should 
consist  of  fish  or  meat  of  a  digestible  character,  with  toast 
or  stale  bread,  followed  by  one  or  more  vegetable  courses, 
and  concluded  with  fruit.  The  beverage  should  be  water, 
or  a  little  lager  beer,  cider,  or  very  dilute  white  wine. 

There  is  rarely  any  necessity  for  more  than  three  meals, 
but  if  some  form  of  supper  seem  necessary  to  insure  sleep, 
a  light  milk  pudding  or  a  few  biscuits  may  be  consumed 
before  retiring. 

(b)  Exercise  of  an  interesting,  exhilarating  nature  and 
in  the  open  air,  systematic  bathing,  and  the  banishment 
of  as  many  of  the  cares  and  worries  of  life,  especially 
at  meal -times,  as  is  possible  are  the  other  means  to  be 
adopted. 

Are  drugs  necessary  in  chronic  biliousness?  Not  as  a 
rule,  for  if  the  over-supply  of  food  to  the  liver  be  arrested, 
that  organ  will  soon,  at  least  in  all  but  severe  cases,  dis- 


THE    TREATMENT    OF    BILIOUSNESS.  173 

gorge  itself  slowly,  and  this  latter  process  will  be  assisted 
by  the  salts  and  water  contained  in  vegetables  and  fruit, 
and  by  the  more  regular  evacuation  of  the  bowels,  which 
will,  by  the  same  measures,  be  also  secured.  At  the  same 
time,  a  bi-weekly  dose  of  some  mineral  water,  rich  in 
salines,  such  as  Hunyadi  Janos,  ^sculap,  Carlsbad, 
etc.,  or  a  teaspoonful  of  Carlsbad  salt  dissolved  in  half 
a  pint  of  hot  water,  and  consumed  slowly  before  break- 
fast, is  permissible,  and  will  often  hasten  the  return  of 
health. 

The  management  of  acute  biliousness,  of  the  bilious  at- 
tack, as  it  is  generally  called,  must,  like  that  of  the  acute 
gouty  attack,  be  conducted  on  the  lines  of  common-sense. 
To  do  nothing  is  generally  the  best  course  to  pursue,  but 
if  a  line  of  treatment  is  demanded,  let  it  be  a  close  imita- 
tion of  the  disorder.  The  patient  feels  sick,  let  him  favor 
vomiting  by  taking  large  draughts  of  tepid  water  con- 
taining a  little  ipecacuan  wine*  or  a  small  quantity  of  salt. 
He  feels  a  tendency  to  diarrhoea,  let  him  take  a  full  dose 
of  some  simple  saline,  such  as  citrate  of  magnesia,  if  he 
dare  not  face  castor  oil.  He  has  no  appetite,  let  him  fast; 
he  is  thirsty,  let  him  drink  water;  he  finds  walking  diffi- 
cult and  noise  trying,  let  him  lie  down  and  be  quiet.  Tris- 
nitrate  of  bismuth  (a  salt-spoonful  in  fresh  soda  water  or 
in  barley  water)  is  permissible  if  irritation  of  the  stomach 
and  intestines  persists  for  long  after  other  symptoms  have 
subsided. 

Such  is  biliousness,  closely  akin  to  gout  in  its  causation, 
course,  and  means  of  cure;  and  I  speak  from  a  large  expe- 
rience in  these  special  disorders,  when  I  state  that  90  per 
cent,  of  the  total  number  of  sufferers  from  either  of  these 

*  Half  a  teaspoonful  of  ipecacuan  wine  to  each  tumbler  of  water, 
to  be  repeated  at  intervals  of  half  an  hour  till  the  desired  effect  is 
produced,  is  an  efficient  method. 


174  DISEASES    DUE    TO    EXCESS    OF    FOOD. 

complaints  may  cure  themselves  by  attention  to  the  simple 
rules  which  I  have  laid  down;  the  odd  10  per  cent,  being 
incurable  because  the  disease  has  lasted  too  long,  and  has 
induced  severe  degeneration  of  the  liver,  kidneys,  etc. ;  and 
in  them  to  cut  the  diet  down  to  the  level  of  those  enfee- 
bled organs  would  simply  mean  slow  starvation.  For  this 
latter  class  the  doctor's  only  aim  and  hope  lie  in  an  ame- 
lioration of  their  condition  by  a  reduction  in  the  grosser 
dietetic  excesses,  and  the  alleviation  of  inevitable  discom- 
forts. But  even  of  the  90  per  cent,  but  a  certain  propor- 
tion recover,  and  yet  all  express  an  ardent  wish  for  a  re- 
turn of  health.  Why  is  this?  Because  they  xAW  not  face 
the  treatment.  Few  of  my  younger  readers  know  the 
difficulties,  the  pains  and  penalties  involved,  in  the  path 
of  reform  of  the  habitual  sinner  whom  habit  has  fixed  as 
in  a  vise. 

Starting  life  with  an  inherited  feebleness  of  the  liver,  the 
rich,  in  order  to  avoid  gout,  must  perforce  practise  the  ut- 
most abstemiousness.  To  think  that  this  course  induces 
permanent  weakness  of  body  or  mind  is  a  mistake.  The 
opposite  is  the  truth :  mental  vigor,  physical  well-being, 
and  prolonged  life,  free  from  those  troubles  so  frequent  in 
old  age  as  to  be  considered  natural  to  it,  are  the  meed  of 
the  ascetic. 

But  before  dismissing  the  twin  subjects  of  gout  and  bil- 
iousness, I  must  briefly  refer  to  two  forms  in  which  all  dis- 
ease may  make  its  appearance,  and  which  have  a  special 
significance  in  these  disorders. 

I  have  hitherto  spoken  of  chronic  gout  and  of  chronic 
biliousness  as  if  these  states  always  ended  rapidly  and 
safely  in  acute  attacks,  in  the  "  crisis  "  of  the  older  medi- 
cal authors.  Unfortunately,  this  is  not  invariably  the  case, 
and  both  these  disorders  may  remain  for  many  years,  the 
sources  of  innumerable  discomforts,  without  any  such  de- 


THE    "crisis"    in    DISEASE.  175 

termined  aiul  powerful  expulsive  process  as  an  acute  at- 
tack being  induced  by  natural  means. 

There  are  individuals,  as  there  are  nations,  whose  living 
units  are  so  little  impressionable  that  evils  accumulate 
among  them  without  exciting  to  a  vigorous  and  healthful 
counter- demonstration,  and  in  such  manner  to  a  cure. 
There  is  evident  discontent,  but  not  rebellion.  This  type 
of  individual  is  well  known  in  every  department  of  medi- 
cine, and  is  exceedingly  common  in  those  of  gout  and  bil- 
iousness. The  diagnosis  of  a  complaint  in  such  people  is 
often  difficult,  and  the  treatment  requires  great  tact.  The 
patient  may  present  himself  in  any  form,  sometimes  as  a 
chronic  dyspeptic,  at  others  as  a  hypochondriac,  at  others 
as  the  subject  of  intermittent  or  persistent  depression  of 
spirits,  or  again  as  an  epilej^tic,  a  consumptive,  a  diabetic, 
an  asthmatic,  or  even  as  an  actual  lunatic.  Nor  is  this  in 
any  sense  an  exaggerated,  or  even  a  completed,  list.  How 
many  persons  of  manifestly  unsound  minds  get  well,  with- 
out physic,  and  simj^ly  by  the  enforced  observance  of  those 
rules  which  I  have  laid  down  for  the  treatment  of  chronic 
gout  and  chronic  biliousness  ?  At  least  one  fourth  of  those 
sent  to  asylums.  If  you  misfeed  the  nervous  system  you 
produce  derangement  of  its  functions,  and  this  is  but  an- 
other term  for  insanity.  Consult  any  book  on  physiology, 
and  you  will  find  that  the  food-system  of  the  body  is  the 
sole  source  of  healthy  function  ;  the  brain  and  nervous 
system  are  but  offshoots  of  a  tree  whose  roots  and  trunk 
are  represented  by  the  food  system.  iSTowhere  in  the  do- 
main of  living  things  do  we  witness  a  nervous  system  ex- 
isting independently  of,  or  except  as  a  branch  of,  the  par- 
ent food  system,  Avhile  throughout  the  vegetable,  and -in 
some  of  the  lower  members  of  the  animal  kingdoms,  we 
may  see  active  life  in  progress  in  the  entire  absence  of 
either  nerves  or  nerve-cells. 


176  DISEASES    DUE    TO    EXCESS    OF    FOOD. 

How,  then,  may  chronic  forms  of  gout  and  biliousness  be 
diagnosed  when  present  in  these  Protean  shapes  ?  I  shall 
not  attempt  to  lay  down  any  rules  for  the  reader's  guid- 
ance except  the  following  common-sense  one  :  when  the 
symptoms  of  lunacy,  epilepsy,  diabetes,  melancholia,  hys- 
teria, or  hypochondriasis  present  themselves,  and  there  is 
no  emdence  of  any  organic  disease  to  account  for  their 
presence,  as  also  when  disorder  in  the  chest  or  abdomen  is 
apparent  without  some  evident  and  sufficient  cause,  the 
chances  are  immensely  in  favor  of  the  supposition  that 
mal-nutrition  of  some  one  or  more  parts  of  the  body,  or 
some  secondary  temporary  derangement  set  up  thereby,  is 
at  the  bottom  of  all  the  phenomena,  and  such  should  be 
diligently  sought  for.  To  people  who  have  never  witnessed 
it,  it  may  appear  at  first  sight  incredible  that  in  some  sim- 
ple but  prolonged  dietetic  errors  can  reside  the  sole  causa- 
tion of  derangements  which  the  text-books  would  have  us 
believe  are  always  dependent  on  some  terrible,  and  gen- 
erally incurable,  lesion.  Let  any  medical  man  who  may 
imagine  that  I  overstate  my  case,  do  what  I  have  done, 
investigate  some  of  the  reported  cases  of  the  cure  of  what 
are  usually  reckoned  as  incurable  ailments,  by  means  of 
the  purgative  remedies  of  quacks,  and  he  will  discover 
that  some  of  the  cases  are  literally  and  absolutely  true. 
He  will  find  himself  confronted  every  now  and  again  with 
people  who  can  produce  absolute  evidence  that  eminent 
medical  authorities  have  regarded  their  cases  as  past  hope 
of  cure,  and  who  yet,  when  so  many  boxes  of  pills  or  so 
many  bottles  of  physic  (usually  a  great  many)  had  been 
consumed,  have  undoubtedly  got  well,  and  remain  so.  The 
efficacy  of  the  treatment  lay  not  in  the  physic,  but  in  the 
method  ;  the  purgation  prevented  largely  the  absorption 
of  food  and  gave  the  excretory  organs  time  to  rid  them- 
selves of  accumulations  of  various  irritating  and  poisonous 


AVIIY    rUIKiATION    OFTEN    CURES.  IVT 

material.  There  can  be  no  doubt  but  that  the  ancient 
physicians,  who  were  keen  observers,  and  not  remarkable 
for  mendacity,  in  this  way  occasionally  scored  the  most 
brilliant  successes,  which  encouraged  them  to  persevere 
in  free  purgation,  emesis,  and  blood-letting,  and  while  we 
may  all  agree  that  they  rode  their  hobby  —  and  their  pa- 
tient —  often  to  death,  there  can  be  no  reason  why  we 
should  not  extract  from  their  practice  the  useful  lessons 
which  it  contained. 

Within  the  past  six  months  it  has  been  my  lot  to  come 
across  two  gentlemen,  a  military  officer  and  a  Scotch  law- 
yer, in  the  former  of  whom  St.  Vitus's  dance,  in  the  latter 
of  whom  incipient  locomotor  ataxia,  were  diagnosed  by 
more  than  one  distinguished  physician,  and  yet  both  of 
whose  cases  were  speedily  diagnosed  as,  and  treated  for, 
latent  gout,  the  first  by  a  London,  the  second  by  an  Edin- 
burgh surgeon.  Both  recovered  promptly  and  completely. 
Nor  was  there  left  in  either  case  any  element  of  doubt  as 
to  the  truth  of  the  diagnosis,  for  both  got  rid  of  the  uric 
acid  in  tangible  shape  and  were  almost  immediately  re- 
stored to  sound  health. 

But  what  about  the  treatment  of  those  cases  of  latent 
gout  and  biliousness  in  which  the  body  will  not  rouse 
itself  to  expel  the  enemy  ?  Once  convinced  of  the  diag- 
nosis, serious  treatment  must  be  commenced.  In  gout  the 
best  of  all  plans  is  to  send  the  patient  straight  off  to  a 
powerful  mineral  spring,  such  as  that  at  Carlsbad  or  Vichy; 
in  biliousness  the  same  line  may  be  followed,  or  the  alter- 
native of  a  short  sea  voyage  may  often  with  advantage  be 
adopted,  for  a  few  hours  of  violent  sickness  will  do  more 
for  the  removal  of  chronic  biliousness,  by  the  induction  in 
sea  -  sickness  of  a  substitute  for  an  acute  attack,  than 
months  of  home  treatment. 

3.  The  third  function  of  the  liver  in  the  order  in  which 
8* 


178  DISEASES    DUE    TO    EXCESS    OF    FOOD. 

I  have  placed  tliem,  is  tliat  concerned  in  the  supply  of 
serum  albumen*  to  the  blood,  which  conveys  it  to  the  tis- 
sues for  their  nourishment. 

If  the  supply  of  albumen  to  the  liver  be  in  excess,  it  is 
but  reasonable  to  conclude  that,  unless  the  organ  be  greatly 
incapacitated,  an  excess  of  serum  albumen  or  plasma  will 
be  thrown  on  the  blood.     To  what  results  will  this  tend  ? 

The  first  result  will  undoubtedly  be  an  increased  ac- 
tivity of  that  chemical  action  which  takes  place  ever  be- 
tween the  living  cells  and  their  albuminous  food,  the 
external  evidences  of  which  will  be  felt  in  a  sense  of  well- 
being  and  of  exaltation  of  all  the  physical  powers.  We 
all  know  how  verj^  different  is  the  sensation  after  a  full, 
from  that  experienced  after  a  restricted,  or  a  purely  veg- 
etarian repast.  Fasting  and  abstinence  from  that  richly 
albuminous  food,  meat,  have  in  all  ages  of  the  world,  and 
in  every  strict  religious  community,  been  rightly  valued  as 
powerful  aids  in  subduing  the  human  passions,  while  even 
among  animals  it  is  to  be  remarked  that  the  carnivores 
are  infinitely  more  combative  and  fierce,  even  when  not 
urged  thereto  by  the  cravings  of  hunger,  than  are  the 
herbivores.  The  lines  of  Pope  in  condemnation  of  the 
slaughter  of  animals  for  the  purposes  of  consummation  and 
the  consequences  thereof  will  be  familiar  to  many  : 

"But  just  disease  to  luxury  succeeds, 
And  every  death  its  own  avenger  breeds  ; 
The  furv-passions  from  that  blood  began, 
And  turned  on  man,  a  fiercer  savage,  man." 

The  consumption,  then,  of  a  constant  excess  of  albumi- 
nous food  leads  very  naturally,  provided  the  stomach  and 
liver  be  not  extensively  deranged,  to  an  over-production 
of  serum  albumen  in  the  blood,  and  a  consequent  stimu- 

*  Serum  albumen  is  here  used  to  designate  what  physiologists  gen- 
erally call  liquor  sanguinis. 


THE    GENESIS    OF    RHEUMATISM.  1*79 

lation  of  cell  activity,  all  of  which  symptoms  are  most 
marked  in  cases  where  meat  forms  the  principal  source  of 
the  albumen,  for  the  albumen  of  meat  differs  from  that 
found  in  vegetable  seeds,  inasmuch  as  it  is  more  easily  ab- 
sorbed, is  more  complex,  and  is  found  in  conjunction  with 
certain  stimulating  nitrogenous  extractives  of  which  cre- 
atin  and  creatinin  are  the  chief. 

But  the  second  set  of  results  which  depend  upon  an  exces- 
sive formation  of  serum  albumen  are  far  more  formidable 
than  those  which  I  have  just  referred  to.     An  increased 
supply  of  serum  albumen  means  of  necessity  also  a  corres- 
ponding increase  of  waste  and  debris  to  be  cast  forth  from 
the  body.     Now,  in  Chapter  VI.  we  studied  the  course  of 
such  waste  from  the  time  of  leaving  the  cells  to  its  final 
exit  from  the  body.    It  falls  first  into  the  spaces  round  the 
cells  (lymph  interspaces),  whence  it  is  pumped  by  the  va- 
rious movements  of  the  body  along  lymph  channels  into 
the  veins,  which  conduct  it  finally  to  the  kidneys  for  ex- 
cretion.    This  debris  is  of  a  crystalloid  nature,  and  imme- 
diately on  leaving  the  cells  consists  of  a  chemical  com- 
pound technically  known  as  an  amine,  which  undergoes 
various  changes  as  it  travels  towards  the  veins,  and  by 
the  time  it  has  reached  that  point,  has,  in  health,  been 
transformed  to  the  same  substance  as  that  other  part  of 
the  albumen  detained  by  the  liver-— namely,  to  urea.    But 
suppose  now  that  a  constant  excess  of  these  amines  is  be- 
ing poured  out  from  the  cells,  and  that  furthermore  this 
occurs  within  the  body  of  an  inactive  man,  one,  in  short, 
who  is  not  keeping  those  great  lymph  pumps,  his  muscles, 
and  those  large  lymph  receptacles  and  pumps  that  exist  in 
the  joints,  round  the  lungs,  round  the  heart,  and  round  the 
bowels,  in  active  working  order — and  what  must,  of  neces- 
sity, ensue  ?     An  accumulation  of  waste  near  and  round 
the  cells,  and  a  failure  in  its  conversion  to  urea  and  in  its 


180  DISEASES    DUE    TO    EXCESS    OF   FOOD. 

due  passage  forward  to  the  veins.  As  a  matter  of  fact — 
though  we  cannot  trace  the  chemical  process — we  know 
that  the  detained  waste  material  undergoes  a  partial  con- 
version to  uric  acid ;  this  is  the  main  poison  which  results 
from  such  detention,  though  there  are  doubtless  other  sec- 
ondary ones.  This  state  of  matters  occurs^generally  in  a 
muscle  for  the  following  reason,  that,  of  the  actively  liv- 
ing portions  of  the  body  the  muscles  form  a  markedly  pre- 
dominant part,  and  that  the  lymph  channels  are  necessarily 
very  much  longer  in  the  muscles,  and  especially  in  the  long 
muscles  of  the  limbs  than  elsewhere.  This  length  of  chan- 
nel favors  obstruction,  stagnation,  and  the  mal-production 
of  urea. 

Now  let  us  consider  what  will  be  the  sequence,  as  re- 
gards the  patient,  of  such  a  state  of  matters  as  I  have 
sketched.  Firstly,  there  will  be  muscular  stiffness  and 
pain,  in  fact,  Muscular  Rheumatism;  then,  if  the  state  of 
matters  be  very  bad,  much  of  the  uric  acid,  etc.,  will  be 
poured  into  the  nearest  lymph  receptacle,  that  round  the 
joint.  Here  it  will  set  \x\)  swelling  and  pain^  and  we  shall 
have  established  a  state  of  Acute  Rheumatism,  popularly 
called  Rheumatic  Fever. 

But  the  mischief  does  not  confine  itself  to  one  joint. 
Once  started  in  the  lymph  S3^stera,  it  augments  by  leaps 
and  bounds,  some  think  by  a  process  of  fermentation  set 
up  by  a  micro-organism,  and  travels  to  other  joints,  or  even 
sets  up  mischief  in  those  large  lymph  receptacles  w^hich 
line  the  lungs  and  diaphragm,  the  brain  and  the  heart,  thus 
producing  those  very  common  concomitants  of  rheumatic 
fevci",  Pleurisy,  Heart  Disease,  and  Inflammation  of  the 
membranes  of  the  Brain  (rheumatic  meningitis),  etc. 

Such  are  the  causation,  course,  rationale,  symptoms,  and 
so-called  complications  of  rheumatism,  acute  and  chronic. 

Its  real  underlying  cause  is,  according  to  the  latest  and 


THE    GENESIS    OF    RHEUMATISM.  181 

the  best  authorities,  uric  acid.  For  long  it  was  held  that 
lactic  acid,  often  found  in  excess  in  the  blood  of  the  rheu- 
matic, was  the  actual  materies  morhi,  but  this  has  been 
found  to  be  a  mistake.  It  is  to  be  regretted  that  many- 
popular  medical  books,  even  those  written  by  scientific 
men,  still  rank  damp,  worry,  anxiety,  etc.,  as  sufficient 
causes.  These  latter  conditions  play  the  same  part  in  de- 
veloping  rheumatism  and  gout  as  they  do  in  developing 
the  symptoms  of  mercurial  and  of  lead  poisoning.  The 
poison  is  already  in  the  tissues,  and  the  unfavorable  con- 
ditions of  damp,  etc.,  by  hampering  the  action  of  the  skin, 
of  the  nervous  system,  etc.,  merely  bring  out  the  enemy, 
compel  him  to  show  his  colors,  earlier  than  he  would  other- 
wise have  done,  but  cannot  create  him.  The  researches  of 
Lehmann  prove  beyond  doubt  that  the  fibrine  of  blood 
{i.  e.,  a  portion  of  the  serum  albumen)  is  increased  largely 
by  a  dietary  in  which  meat  is  much  represented,  and  that 
in  rheumatic  fever  as  much  as  ten  parts  per  thousand  of 
fibrine  have  been  found  in  the  blood,  as  against  three  parts 
per  thousand,  which  is  the  average  of  health.  Knowing, 
then,  that  uric  acid  is  the  poison  in  rheumatic  fever,  and  is 
always  a  result  of  an  arrested  metamorphosis  in  the  final 
stages  which  albuminous  food  undergoes,  and  that  any  in- 
crease in  the  consumption  of  such  food  is  followed  by  an 
increase  of  fibrine,  and  that  such  fibrine  in  an  attack  of 
rheumatic  fever  exists  always  in  excessive  amount  in  the 
blood-current,  we  are  at  least  justified  in  holding  that  there 
is  a  distinct  connection  between  a  large  consumption  of  al- 
bumen and  the  production  of  rheumatic  fever.  Further- 
more, there  is  overwhelming  evidence  that,  other  things 
being  equal,  a  restricted  dietary  has  a  most  powerful  effect 
in  averting  the  attacks. 

But  it  is  impossible  to  dismiss  so  briefly  the  discussion 
of  such  a  universal  complaint  as  rheumatism.     Let  us  first 


182  DISEASES    DUE    TO    EXCESS    OF    FOOD. 

trace  the  cause  of  the  chronic  rheumatism  so  commonly 
witnessed  in  the  aged,  and  usually  in  those  who  have  passed 
hard  lives  and  have  fared  badly.  If  rheumatism  be  even 
distantly  related  to  over-eating  and  to  want  of  exercise, 
how  is  it  that  the  hardest  worked  and  the  half  starved  form 
the  bulk  of  the  sufferers  ?  Such  is  the  question.  The  an- 
swer is  an  easy  one. 

The  two  closely  allied  complaints,  gout  and  rheumatism, 
have  each  a  poison,  uric  acid.  The  sole,  the  only  possible 
source  of  this  acid  is  albuminous  food,  and  it  is  produced 
whenever  the  amount  of  albumen  consumed  is  in  excess  of 
the  digestive  powers. 

Therefore,  weakness  of  the  digestive  functions,  in  other 
words,  weakness  of  the  whole  body — for  the  digestion  goes 
on  throughout  every  portion  of  the  body — may  cause  either 
of  these  complaints  quite  as  easily  as  a  gross  excess  of  food. 

Once  produced,  if  the  kidneys  and  skin  remain  active  or 
their  functions  be  not  subjected  to  sudden  interruptions, 
many  years  may  elapse  ere  the  symptoms  of  either  com- 
plaint will  be  developed. 

Want,  therefore,  equally  with  luxury,  excess  of  exercise 
equally  with  a  deficiency  thereof,  may  furnish  favorable 
conditions  for  the  production  of  gout  and  rheumatic  poi- 
sons, while  deficient  clothing,  exposure  of  the  skin  to  sud- 
den and  chilling  draught,  damp,  worry,  anxiety,  want  of 
sleep,  old  age,  alcoholic  excess,  in  fact  anything  or  every- 
thing that  interferes  with  the  excretory  powers  of  the  body 
or  lowers  its  tone,  will  precipitate  the  attack. 

Then  we  have  many  varieties  of  rheumatism  or  pseudo- 
rheumatism,  for  the  poison  is  probably  not  in  any  of  these 
cases  uric  acid.     The  following  are  the  principal  ones  : 

Fever  rheumatism.  The  aching  of  the  joints  which  com- 
monly precedes  all  feverish  attacks.  The  poison  in  each 
case  varies  with  the  fever. 


THE    TREATMENT    OF    CHRONIC    RHEUMATISM.  183 

iScarlatinal  rheumatism.  Usually  a  pseudo-rheumatism, 
sometimes  a  veal  acute  rheumatism,  which  makes  its  ap- 
pearance in  the  middle  and  towards  the  end  of  the  fever. 

Lead  and  mercurial  rheumatism,  due  to  the  presence  of 
those  minerals  in  the  tissues. 

Syphilitic  and  gonorrhcecd  rheumatism,  due  to  special 
venereal  poisons. 

Eheumatic  Gout.  —  This  complaint,  with  a  misleading 
name,  has  no  connection  whatever  with  either  gout  or 
rheumatism,  but  is  a  chronic  inflammatorv  affection  of 
the  joints,  of  unknown  causation,  and  exceedingly  per- 
sistent and  intractable. 

The  line  of  treatment  in  rheumatism  will  now  be  clear 
to  us  and  will  be  found  to  coincide  very  closely  with  that 
which  has  received  the  sanction  of  popularity. 

The  Treatment  of  Chronic  Rheumatism. 

(a)  The  removal  of  the  cause  is  very  naturally  the  first 
object.  In  all  but  the  old  or  the  very  debilitated,  the 
dietary  should  in  the  first  instance  be  revised.  Meat  food 
should  be  taken  only  at  one  meal,  and  should  then  be  con- 
sumed with  bread  or  toast,  and  followed  by  vegetable  and 
fruit  courses  only.  Potatoes,  milk  puddings,  and  sweets 
generally,  should  at  this  meal  be  shunned.  In  the  very 
robust,  especially  if  acute  rheumatism  threaten,  it  is  well 
to  insist  for  a  time  on  a  rigid  vegetarianism.  The  result 
will  nearly  always  repay  the  first  trouble  and  discomfort 
attendant  on  the  dietetic  change.  Sweet  wines,  malt  liq- 
uors, and  usually  all  forms  of  alcohol,  must  be  avoided. 
The  cause  of  the  specially  deleterious  effects  of  such  bev- 
erages on  weak  digestive  organs  will  be  referred  to  in 
future  pages. 

(b)  Exercise,  to  assist  the  muscles  to  get  rid  of  their 
accumulations  of  waste,  must,  if  no  fever  be  present,  and 


184  DISEASES    DUE   TO    EXCESS    OF    FOOD. 

sometimes  even  in  the  face  of  pain,  be  insisted  on.  En- 
forced active  exercise  will  often  suffice  to  cure  very  old- 
standing  cases.  If  the  patient  be,  however,  old  or  very 
feeble,  great  caution  is  required,  lest  over-fatigue  be  in- 
duced, and  in  their  cases  thorough  massage  (^.  e.,  passive 
muscular  exercise)  may  replace  other  forms  of  exercise. 

Local  rheumatic  pains  are  best  dispelled  by  firm,  pro- 
longed, and  repeated  frictions.  Galvanism  may  be  sub- 
stituted if  friction  fails,  a  fairly  powerful  current  being 
passed  through  the  muscle  for  three  to  five  minutes,  thrice 
daily. 

Sometimes  it  is  well,  in  addition  to  the  mechanical  fric- 
tion, to  avail  ourselves  of  some  remedy  which  shall  relieve 
the  congested  state  of  the  muscles  by  deflecting  some  of 
its  contained  blood  to  the  skin.  For  this  purpose  some 
one  of  the  stimulating  liniments  in  frequent  use  may  be 
employed.  A  drachm  of  menthol,  dissolved  in  a  couple 
of  ounces  of  the  common  soap  liniment,  acts  well,  while, 
for  severe  cases,  3  drachms  of  menthol,  4  drachms  of  pure 
chloroform,  and  9  drachms  of  olive  oil  may  be  safely  used. 
The  friction  is  of  much  more  importance  than  the  variety 
of  liniment  employed. 

(c)  Bathing,  by  keeping  the  skin  in  a  condition  of  ex- 
cretory efficiency,  is  also  of  importance.  For  the  young 
and  robust  a  weekly  vapor  or  Turkish  bath,  is  often  ad- 
visable, while  for  the  middle-aged,  or  the  elderly,  frequent 
warm  baths  (one  every  night  or  every  second  night  before 
retirinor  to  rest)  are  usuallv  serviceable.  Even  a  cold 
morning  tub,  by  producing  as  its  secondary  effect  flushing 
of  the  skin,  is  a  measure  of  treatment  of  which  the  young 
may,  if  the  subject  of  slight  rheumatism,  avail  themselves. 
In  old  chronic  cases  the  hot  seaweed  baths  at  Ramsgate, 
or  the  warm  saline  baths  at  Buxton,  Bath,  or  Ashby-de-la- 
Zouche  are  useful. 


TREATMENT    OF    CHRONIC    KlIEUMATISM.  185 

(d)  Clothing  is  a  subject  of  great  importance,  both  in 
chronic  gout  and  in  the  same  form  of  rheumatism.  It  is 
desirable  that  sudden  chilling  of  the  skin  should  be  avoided, 
and  that  a  stratum  of  warm,  dry  air  should  envelope  the 
body.  This  can  best  be  secured  by  flannel  or  silk  under- 
clothing. In  the  case  of  chronic  sufferers  the  flannel  may 
beneflcially  be  rough,  as  it  then  plays  the  part  of  a  mild 
cutaneous  irritant.  This  property  of  irritation  possessed 
by  the  rougher  flannels  is,  however,  a  drawback  sometimes 
to  their  use,  and  people  of  sensitive  skin  have  often  to  inter- 
pose a  lattice-work  cotton  garment  between  the  skin  and 
the  flannel,  or  to  substitute  material  such  as  merino,  made 
from  the  finer,  softer  wools,  or  silk  garments,  for  the  coarser 
flannel  ones.     The  under  flannel  garment  should  fit  loosely. 

(e)  Climate.  The  importance  of  climate  in  the  treat- 
ment of  a  disease  which  is  so  readily  brought  out  by  any- 
thing, such  as  the  presence  of  much  moisture  in  the  air  or 
sudden  changes  in  its  temperature,  that  hampers  the  action 
of  that  very  extended  excretory  layer,  the  skin,  is,  it  will 
be  readily  understood,  very  great.  The  persistence  of  very 
many  cases  of  chronic  rheumatism,  in  the  face  of  all  meas- 
ures, however  wisely  chosen  for  their  relief,  is  often  due 
to  the  simple  fact  that  the  sufferers  reside  on  a  damp, 
usually  a  clay^  soil.  Such  cases  cure  themselves  sponta- 
neously upon  change  to  a  dry  soil,  and  when  this  can  be 
secured,  in  conjunction  with  a  warm,  sunny  climate,  the 
gain  to  the  invalid  is  always  assured.  In  Great  Britain, 
Ventnor,  Bournemouth,  Hastings,  and  St.  Leonards  may 
be  mentioned  as  among  desirable  winter  resorts  ;  while 
of  the  foreign  ones,  Rome,  Naples,  the  JMediterranean 
shores.  Upper  Egypt,  llelouun  near  Cairo,  or  llamman 
R'hiva  in  Algeria,  the  two  latter  places,  being  especially 
suitable  both  for  their  climate  and  for  their  celebrated  hot 
baths,  are  to  be  commended. 


186  DISEASES    DUE    TO    EXCESS    OF    FOOD. 

(/')  Medicinal  agents  may  sometimes  with  good  reason 
be  had  recourse  to  in  chronic  rheumatism,  especially  in  the 
case  of  those,  the  vast  majority  of  sufferers,  who  are  from 
poverty  more  or  less  debarred  the  employment  of  the  more 
reliable  and  only  j^ermanent  means  of  relief,  those  to  which 
I  have  already  drawn  attention.  It  is  certain  that  good  is 
often  derived,  especially  in  localized  rheumatism,  from  pro- 
longed friction  w^th  some  mild  skin  stimulant.  In  very 
obstinate  cases  it  is  justifiable  to  go  even  beyond  this 
point  and  apply  counter-irritants.  Of  these,  very  hot 
moist  bran  poultices,  covered  with  flannel  or  some  water- 
proof material,  and  applied  continuously  for  a  day  or  two, 
if  necessary,  to  the  seat  of  pain,  often  effect  a  ready  cure; 
while  in  other  cases,  a  very  small  blister,  or  series  of  small 
blisters,  a  fresh  one  being  applied  each  day  in  the  close 
neighborhood  of  the  last,  or  a  mustard-leaf,  or  a  few  ap- 
plications of  liniment  of  iodine,  or  a  single  touch  of  Cor- 
rigan's  hammer,  or  of  the  dermo-puncture — the  former  a 
metal  button  whicli,  after  it  has  been  immersed  for  a  min- 
ute in  boiling  water,  is  applied  momentarily  to  the  skin 
over  the  seat  of  pain;  the  latter  an  arrangement  of  needles 
which,  released  by  a  spring,  pierce  the  skin  and  are  at  once 
retracted — or  a  few  jets  of  the  vapor  of  chloride  of  methyl, 
are  sometimes  very  useful,  though  I  deprecate  strongly  the 
use,  but  in  cases  of  great  severity  and  where  the  pain  is 
purely  local,  e.  ^.,  in  sciatica,  of  such  strong  measures. 

Internal  remedies  are  rarely  called  for.  The  young  and 
robust  may,  however,  ofttimes,  to  their  advantage,  take  a 
tri-weekly  dose  of  some  purgative  saline  mixed  with  a  large 
quantity  of  water,  while  the  mineral  waters  of  Bath,  of 
Buxton,  of  Strathpeffer,  the  sulphurous  waters  of  Harro- 
gate, the  iodized  waters  of  Woodhall,  the  alkaline  waters  of 
Vichy,  and  the  antacid  springs  of  Carlsbad  will  often,  when 
the  patient  consumes^  these  waters  at  their  sources,  but  rare- 


TREATMENT    OF    CHRONIC    RHEUMATISM.  187 

ly  under  other  coiiditions,  avail  to  relieve  very  consider- 
ably the  most  chronic  cases. 

Such  are  the  lines  of  treatment  from  which  a  selection 
may  be  made,  but  it  is  necessary  here  to  add  the  proviso 
that,  in  a  certain  number  of  special  cases,  all  of  them  may, 
from  various  causes,  fail.  Who,  after  all,  are  the  great 
martyrs  to  rheumatism  and  fill  the  air  of  the  out-patient 
departments  of  our  hospitals  and  dispensaries  with  their 
lamentations  ?  The  elderly  and  aged  poor  ;  those  who 
have  led  hard  lives,  who  have  worked  excessively  and  fed 
indifferently.  Their  bodies  are  prematurely  broken  down ; 
their  muscular  tissues  clogged  with  all  forms  and  varieties 
of  irritating  nitrogenous  debris,  while  the  present  need  of 
suitable  nourishment,  of  proper  clothing,  of  pure  air,  and 
of  sufhcient  rest,  renders  their  temporary  relief  doubtful, 
and  their  permanent  cure,  under  the  persistence  of  such 
evil  conditions,  an  impossibility.  Rest,  warmth,  and  sim- 
ple suitable  food  are  the  first  conditions  to  be  secured, 
and  the  cure  may  be  expedited  by  counter-irritation  and 
by  the  administration  of  some  tissue  stimulant,  of  which 
the  best  are  iodide  of  potassium,  chloride  of  ammonium, 
and  guaiacum.  The  two  former  may,  with  great  advan- 
tage, be  given  together,  thus  :  Take  of  iodide  of  potas- 
sium and  of  chloride  of  ammonium,  of  each,  1  drachm;  of 
syrup  of  orange,  2  oz. ;  of  compound  tincture  of  Peruvian 
bark,  1^  oz. ;  of  caraway  w^ater,  2^  oz.  Mix,  and  direct  that 
a  small  tablespoonful  in  plenty  of  water  be  taken  trice 
daily. 

The  above  mixture  may,  if  necessary,  be  continued  for 
as  long  as  a  month,  and  is  of  remarkable  temporary  bene- 
fit in  old-standing  cases  of  rheumatism,  as  even  in  those 
of  chronic  gout  and  chronic  biliousness.  Sometimes  in 
the  old  and  very  weak  the  following  is,  however,  prefer- 


188  DISEASES    DUE   TO    EXCESS    OP    FOOD. 

able.  Take  of  ammoniated  tincture  of  guaiacum,  4 
drachms;  of  tincture  of  orange-peel,  2  drachms;  of  muci- 
lage of  tragacanth  and  of  cinnamon  water,  of  each,  3^  oz. 
Mix,  and  direct  that  two  tablespoonfuls  be  taken  in  water 
thrice  daily. 

Treatment  of  Acute  and  Sub-acute  HJieumatism. 

The  remarks  made  on  the  subject  of  treatment  when 
acute  gout  and  acute  biliousness  were  the  complaints  in 
question,  apply  with  equal  force  to  acute  rheumatism. 

The  disease,  painful  and  prolonged  though  it  generally 
is,  is  nevertheless  the  shortest  and  easiest  route  to  health, 
consistently  with  complete  recovery,  that  has  yet  been  dis- 
covered. 

The  line  of  treatment  must  again  be  traced  on  the  lines 
of  Nature.  The  swelled  and  heated  joints  should  be  en- 
veloped in  cotton-wool,  over  which  it  is  an  advantage  to 
fasten  gutta-percha,  or  other  waterproof  tissue,  or  they 
may  be  encased  in  very  hot  bran  bags,  frequently  changed. 

The  intensely  acid  and  copious  perspiration,  peculiar  to 
the  complaint,  must  be  fostered  by  flannel  clothing,  by  a 
dry,  warm  temperature  of  the  bedroom,  and  by  copious 
draughts  of  water.     Absolute  rest  is  essential. 

The  diet,  of  course,  must  be  of  the  lightest.  In  cases 
in  which  simple  treatment  only  is  adopted,  light  soups  and 
broths,  malt  extracts  with  water,  barley  water,  rice  water, 
cocoatine,  and  fresh,  ripe,  digestible  fruits  in  small  quanti- 
ties should  form  the  mainstay.  You  cannot  feed  a  pa- 
tient up  in  fever  ;  you  may  in  truth  stimulate  him  by  ad- 
ministering a  profusion  of  meaty  substances  rich  in  stim- 
ulant properties,  but  you  cannot,  by  the  mere  supply  of 
food,  compel  the  cells  to  unite  with  albumen  as  in  health. 
Even  in  mild  forms  of  fever  this  process  is  very  consider- 
ably impaired,  Avhile  in  severe  cases  a  breaking  down  of 


ACUTE  AND  SUB-ACUTE  KHEUMATISM.  189 

the  cell-tissue  only  is  in  progress,  no  reconstruction  what- 
ever taking  place.  In  some  cases  a  milk  diet  may  be  tried, 
from  two  to  five  pints  of  this  fluid,  with  an  equal  quantity 
of  soda  or  potash  water,  being  a  daily  allowance.  But  if 
a  one-substance  diet  is  to  be  undertaken,  let  it  consist 
rather  of  buttermilk  than  of  milk.  I  have  treated  about 
a  score  of  cases  in  this  way,  allowing  from  one  to  three 
quarts  or  more  of  buttermilk,  or,  where  this  is  distasteful, 
one  or  two  large  bottles  of  koumiss,*  to  be  consumed  per 
diem.  In  these  cases  I  have  administered,  in  addition  to 
this,  neither  nourishment  (beyond,  in  one  or  two  cases,  a 
little  bread,  toast,  or  ripe  fruit)  nor  medicine,  and  the  re- 
sults have  been  most  satisfactory. 

As  regards  the  administration  of  medicine,  I  have  little 
to  advise  beyond  extreme  caution,  and  the  exercise  of 
much  patience  ere  recourse  be  had  to  it  at  all.  Remem- 
ber that  the  complaint  is  both  beneficial  and  protracted, 
and  that  if  the  patient  is  fairly  convalescent  in  eight  weeks, 
he  may  be  considered  to  have  done  well.  The  best  treat- 
ment is  that  which  does  nothing,  and  the  next  best  that 
w^hich  does  little,  and  of  the  latter  order  first  in  rank  may 
be  mentioned  the  lemon-juice  treatment.  Half  an  ounce 
of  this  fluid,  quite  fresh,  should  be  administered  in  water 
without  sugar,  night  and  day,  every  four  hours.  In  cases 
where  this  line  is  adopted  it  is  not  advisable  to  administer 
either  buttermilk  or  koumiss.  With  reofard  to  the  so- 
called  alkaline  and  salicylic-acid  treatments,  I  have  noth- 
ing good  to  say.  The  former  is  depressing  and  consider- 
ably increases  the  period  of  convalescence,  while,  in  the 
majority  of  cases,  it  has  no  noticeable  effect  in  even  reliev- 
ing pain.  The  latter — the  employment  of  salicine,  salicy- 
lic acid,  and  the  salicylates — is  every  day  losing  its  votaries, 


*  Koumiss  contains  a  variable  amount  of  alcohol. 


190        DISEASES  DUE  TO  EXCESS  OF  FOOD. 

in  view,  among  many  other  drawbacks,  of  the  extraordinary 
depression,  the  frequent  relapses,  and  the  long  subsequent 
stage  of  anremia  which  this  line  of  treatment  always  en- 
tails. Both  colchicum  and  salicine,  with  their  derivatives, 
belong  to  an  exceedingly  dangerous  class  of  drugs,  and 
their  danger  lies  in  the  seductiveness  of  their  primary  ef- 
fects. They  have  both  been  proved  by  unanswerable 
experiments  to  be,  mainly,  potent  bile  stimulants.  They 
stimulate,  in  short,  the  bile-forming  function  of  the  liver, 
and  cause,  therefore,  of  necessity,"  a  temporary  check  in  the 
production  of  uric  acid,  when,  as  in  gout,  this  substance  in 
place  of  urea  is  being  poured  into  the  blood-stream,  and 
they  con  sequent h^  also  arrest  more  or  less  the  supply  of 
serum  albumen  to  the  tissues,  and  thus  check  temporarily 
the  symptoms  of  rheumatic  fever.  But  such  stimulation 
can  have  but  one  result,  a  temporary  arrest  of  symptoms 
— which  symptoms,  be  it  noted,  are  admitted  by  all,  at  any 
rate  in  gout,  to  be  beneficial — at  the  exj^ense  of  only  a 
partial  recovery  and  of  an  early  and  severe  relapse.  The 
public  have  long  ago  discovered  by  painful  experience  the 
truth  of  these  statements  in  regard  to  colchicum  in  gout, 
for  the  disease  is  a  common  one,  and  the  remedy  is  of  old 
standing;  in  that  of  salicine  compounds  the  real  state  of 
matters  is  only  now  being  suspected.  So  far  from  being, 
what  their  admirers  concluded  from  the  review  of  these 
drugs  through  the  rose-colored  glasses  of  hope,  antidotes 
to  some  fancied  microbe  which  was  laying  waste  the  king- 
dom of  man  in  rheumatic  fever,  it  has  been  found  that,  in 
order  to  maintain  the  relief  of  pain,  the  use  of  the  drugs 
must  be  vigorously  kept  up,  a  necessity  quite  incompatible 
with  the  microbe  theory  unless  its  supporters  were  pre- 
pared to  "  go  one  better,"  and  to  assert  that  the  supposed 
microbe  was  also  a  supposed  phoenix.  But,  as  I  have  al- 
ready said,  the  absurd  pretensions  as  to  the  powers  of  the 


THE    SALICYLIC    TREATMENT    OF    RHEUMATISM.         191 

salicine  compounds  find  every  year  fewer  supporters.  The 
therapeutists  are  steadily,  in  each  new  edition  of  their 
works,  less  inclined  to  commit  themselves  to  the  miracu- 
lous powers  of  these  drugs,  while  Dr.  Latham,  Professor 
of  Medicine  at  Cambridge,  and  a  man  who  may  be  classed 
as  a  specialist  of  the  first  rank  on  the  subject  of  rheumatism, 
in  his  learned  Croonian  Lecture  in  1886,  on  gout,  rheuma- 
tism, and  diabetes,  did  not  consider  them,  among  rational 
methods  of  treatment,  as  worthy  even  of  a  passing  refer- 
ence. 

Nevertheless,  there  exist  cases  in  which  both  the  salicine 
compounds  and  the  colchicum  preparations  may  be  em- 
ployed, just  as  there  exist  derangements  in  which  brandy, 
whisky,  rum,  etc. — though  to  their  incautious  use  is  due 
much  of  the  physical  suffering  we  every  day  witness,  and 
perhaps  the  very  diseases  we  may  happen  to  be  treating — 
ma}^  be  used  as  means  of  relief  to  tide  over  a  critical  period. 
There  is  no  form  of  matter  in  the  world  that  is,  as  regards 
man,  intrinsically  good  or  intrinsically  evil,  all  are  relative 
benefits,  and  the  duty  of  the  thoughtful  man  is  not  to  brand 
any  one  of  them  with  indiscriminating  reproach  or  praise, 
but  to  point  out,  for  the  benefit  of  others,  the  true,  and  often 
very  restricted,  limits  within  which,  in  any  given  class  of 
cases,  every  one  of  them  may  find  useful  employment. 

But  before  I  finally  dismiss  the  three  derangements — 
gout,  biliousness,  and  rheumatism — so  intimately  related 
both  in  their  causation  and  in  the  phenomena  to  which 
they  give  rise,  I  must  refer  to  two  important  groups  of 
symptoms  common  to  all  of  them.  The  first  of  these  con- 
sists of  : 

The  Skin  Derangements  consequent  on  Chronic  Gout, 
Rheumatism,  or  Biliousness. 

To  the  reader  who  has  carefully  followed  me  thus  far,  it 
will  not  come  as  a  surprise  to  be  told  that,  as  the  skin  is 


192  DISEASES    DUE    TO    EXCESS    OF    FOOD. 

a  blood-purifying  organ  in  as  true  a  sense  as  the  lungs  and 
kidneys,  upon  it  will  fall,  when  the  kidneys  fail,  as  they 
do  so  frequently  in  these  allied  complaints — but  most  com- 
monly of  all  in  gout — an  increased  strain,  and  that  such 
strain,  when  long  continued,  will  lead  to  symptoms  of  de- 
rangement in  those  parts  upon  which  it,  for  some  special 
reason,  most  of  all  tells.  How  often  do  we  not  witness  in 
a  class  of  man  who  is  evidently  over-fed,  and  who  is  al- 
ways complaining  of  a  number  of  vague  ailments  refer- 
able to  his  liver,  but  not  clearly  definable  as  either  gout, 
rheumatism,  or  biliousness,  that  the  least  interference  with 
the  action  of  the  skin,  the  incautious  application,  for  ex- 
ample, of  a  plaster  for  some  vague  pain,  will  produce 
rapidly  a  crop  of  Eczema,  and  how  often  do  we  not  see 
the  same  complaint  among  the  children  of  the  ill-fed 
poor  ! 

I  shall  not  attempt  any  classification  or  even  any  enu- 
meration of  skin  diseases  in  this  place,  but  shall  simply 
say  that  whenever  any  individual  witnesses  on  his  skin  any 
sign  of  over-action — ^.  e.,  congestion  or  inflammation — from 
the  smallest  pimple,  or  the  simplest  boil,  up  to  the  most 
general  and  intractable  case  of  chronic  psoriasis,  and  that 
such  symptom  is  not  clearly  traceable  to  the  presence  of 
some  animal  parasite  (such  as  the  itch-insect)  or  of  some 
vegetable  parasite  (such  as  one  of  the  varieties  of  tinea 
which  are  the  sufticient  causes  of  ringworm,  honeycomb- 
ringworm,  barbers'  itch,  liver  spot,  or  circumscribed  bald- 
ness), and  the  sum  total  of  all  such  parasitic  affections  do 
not  go  to  make  up  one  tenth  of  the  total  number  of  skin 
diseases — he  may  rest  assured  that  his  skin  has  for  long 
been  making  strenuous  efforts  to  eliminate  some  poison 
from  his  blood-stream,  and  that  some,  often  very  trifling, 
extra  task  thrown  on  it  has  resulted  in  a  local  breakdown 
of  the  organ,  generally,  of  the  nature  of  a  temporary  cura- 


THE    MEANING    OF    SKIN    ERUPTIONS.  193 

tive  inflammatioT],  but  sometimes  of  a  permanent  degenera- 
tive form,  the  result  of  old- standing  disease  and  persistent 
and  unsuspected  overwork  of  the  skin,  aided  perhaps  by- 
congenital  weakness  of  that  part. 

The  rational  treatment  of  all  skin  disease  consists  in  find- 
ing first  of  all  the  special  poison  present,  in  tracing  its 
source,  and  in  preventing  its  further  formation  in  the  body, 
and  then  in  eliminating  from  the  body  the  poison  already 
contained  therein. 

How  often  have  I  not  heard  a  protest  raised  by  some 
old  woman  in  the  out-patient  rooms  of  one  of  our  large 
hospitals  against  the  attempt  made  by  some  youthful 
medico  to  plaster  up  with  some  form  of  unguent  a  re- 
cent and  violent  attack  of  inflammation  of  the  skin  {i.  e., 
eczema),  and  what  a  smile  of  scorn  have  I  seen  passing 
over  the  features  of  the  said  ^sculapius.  IS'evertheless, 
the  old  woman  must  be  impartially  adjudged  to  be  in  the 
right.  To  "  drive  in  the  complaint " — for  such  is  the 
phraseology,  also  strictly  correct,  of  the  aged  female — is 
to  excite  in  its  stead  bronchitis,  diarrhoea,  or  the  much- 
dreaded  "fits."  A  very  slight  knowledge  of  physiology 
must  convince  every  one  of  the  reality  of  this  risk.  That 
inflammation  of  the  skin  is  but  the  effect  of  an  adequate 
cause,  to  be  sought  probably  in  some  dietetic  error,  no  one 
will  venture  to  doubt,  and  that  to  leave  the  cause  in  oper- 
ation while  attempting  to  remedy  the  local  effect,  is  but  to 
divei^  to  some  other  organ — at  first  probably  to  one  of 
allied  function,  such  as  the  lungs,  but  possibly  to  the 
brain — the  said  effect. 

In  youth,  all  that  is  necessary,  all  that  can  be  beneficial, 
in  the  way  of  treatment  in  skin  disease,  is  to  give  such  di- 
rections as  shall  insure  to  the  sufferer  the  known  conditions 
necessary  to  general  health.  When  these  have  been  se- 
cured, and  the  materies  morhi  actually  present  have  been 
9 


194  DISEASES   DUE    TO    EXCESS    OF   FOOD. 

removed,  then  it  is  time  to  treat  the  local  skin  disease,  if 
it  then  remain,  which  is  extremely  unlikely. 

The  Lung  Derangements  consequent  on  Chronic  Gout, 
llheumatism,  or  Biliousness. — We  have  seen  why  it  is  that 
pleurisy  is  a  common  and  well-recognized  complication  of 
acute  rheumatism.  There  can  be  no  doubt  but  that  many 
of  the  attacks  oi  pleurisy  that  come  on  without  assignable 
cause  are  due  also  to  one  or  other  of  the  three  above-men- 
tioned complaints,  existing  in  their  latent  condition,  but  I 
should  be  wrong  to  say  that  as  yet  the  connection  between 
it  and  them  can  be  in  every  case  accurately  traced.  Bron- 
chitis^ however,  in  all  its  forms,  and  asthma  (of  one  variety, 
that  connected  w^ith  a  transient  congestion  of  the  mucous 
membrane  of  the  bronchial  tubes),  as  also  several  forms  of 
laryngeal  derangement,  have  long  been  recognized  as  com- 
mon gouty  and  rheumatic  symptoms,  and  scientifically 
tracked  to  such  origin.  In  biliousness  of  the  chronic  form 
both  lung  and  skin  derangements  are  comparatively  rare, 
for  the  special  derangements  in  this  complaint  are  more 
localized,  being  confined  more  strictly  to  the  liver,  than 
are  those  attendant  on  gout  and  rheumatism. 

I  need  scarcely  add  that  all  lung  complaints,  like  all  skin 
disorders,  which  are  due  to  the  existence  of  poison  of  any 
sort  in  the  blood,  are  of  the  nature  of  benefits,  and  that 
the  sole  rational  line  of  treatment  is  first  to  cut  off  further 
supplies  of  the  poison,  and  then  to  rid  the  body  of  that 
amount  with  which  it  is  already  encumbered,  by  either 
w^isely  aiding  and  abetting  the  development  of  such  symp- 
toms as  may  be  present,  or  by  attemj^ting  to  set  up,  in 
some  organ  of  similar  function,  but  of  less  importance  to 
life,  such  as  the  skin,  similar  symptoms.,  and  thus  to  relieve 
the  great  strain  thrown  on  the  breathing  apparatus.  To 
attain  these  ends,  while  soothing  the  lung  tissue  by  warm- 
ing and  perliaps  moistening  the  atmosphere,  we  apply  lin- 


DETERMINING    CAUSES.  195 

seed  meal  or  mustard  to  the  skin  of  the  chest,  we  reform 
and  simplify  the  dietary,  and  we  administer  hot  demulcent 
drinks  to  favor  expectoration,  or  even  recommend  a  few 
doses  of  ipecacuan  or  antimonial  wine. 

The  great  facts,  then,  that  we  must  keep  in  mind  are, 
that  the  kidneys,  skin,  and  lungs  are  all  excretory  organs, 
each  in  health  provided  with  its  own  special  amount  and 
variety  of  work,  but  each,  when  the  action  of  either  of  the 
other  two  is  impeded,  liable  to  be  called  on  to  undertake 
extra  duties,  and  thus  to  become  itself  overstrained  and  at 
the  mercy  of  a  slight  adverse  force — in  the  case  of  the 
skin,  the  application  perhaps  of  a  strong  soap  or  the  rub- 
bing of  some  article  of  apparel  ;  in  the  case  of  the  lungs, 
a  sudden  fall  in  the  temperature  or  the  prevalence  of  a 
cold,  dry,  east  wind — which  may  suffice  to  produce  dis- 
ease. 

Neither  ordinary  damp,  nor  cold,  nor  fog,  nor  worry, 
nor  anxiety,  nor  any  other  condition  nor  state,  can  pro- 
duce the  poison  of  gout,  rheumatism,  or  biliousness,  nei- 
ther can  they  or  any  one  of  them  produce  in  a  healthy 
individual,  whose  ancestors  like  himself  have  been  accus- 
tomed to  live  in  a  climate  where  such  conditions  are  com- 
monly met  with,  any  disorder,  but,  when  certain  tissues  of 
the  body  are  already  disordered  from  overwork,  they  may 
act  as  determining  causes  of  the  outbreak.  To  the  wide 
variations  in  climate  and  temperature,  etc.,  the  English- 
man owes  his  vigor  of  body,  and  especially  that  adapta- 
bility of  his  cells  which  makes  of  him  an  excellent  colo- 
nist. Placed  under  what  the  hygienists  would  call  better 
conditions,  he  would  actually  degenerate  in  those  great 
qualities  which  have  made  him  the  pioneer  of  civilization, 
while  the  health  of  the  race — a  state  of  equilibrium  which 
has,  of  itself,  nothing  to  do  with  muscular  vigor  or  even 
but  remotely  with  adaptability — would,  after  the  difficul- 


196  DISEASES   DUE    TO    EXCESS    OF    FOOD. 

ties  of  acclimatization  have  been  surmounted,  remain  much 
as  it  is  at  present. 

There  are  yet  many,  but  less  important,  dependencies 
of  the  three  diseases  of  which  I  have  been  treating,  a  de- 
tailed description  of  which  would  delay  us  too  long,  and 
whose  connection  with  gout,  biliousness,  and  rheumatism 
is  not  always  quite  direct.  Of  these  Quinsy,  some  neural- 
gias, various  forms  of  headache,  many  varieties  of  Epilepsy, 
might  be  quoted  as  instances,  and  these  will  receive  nec- 
essary attention  when  the  question  of  the  degenerations 
of  the  organs  in  which  they  occur  comes  before  our  no- 
tice. 

There  remain  for  us  to  consider  two  important  liver 
functions,  either  of  which  may  fail  as  a  result  of  excess. 

4.  The  glycogen  -  storing  function  may  become  disar- 
ranged.— Let  us  make,  first  of  all,  a  brief  study  of  this 
function,  and  then  we  shall  be  able  very  clearly  to  trace 
the  genesis  of  the  symj^toms  which  ensue  on  its  failure, 
and  to  distinsfuish  from  each  other  two  verv  different 
complaints,  Temporary  Glucosuria  or  Functional  Diabetes, 
and  Permanent  Glucosuria  or  Organic  Diabetes. 

All  the  carbo-hydrate  section  of  the  fuel-foods  —  i.  e., 
the  starches  and  sugars — when  they  reach  the  liver  are 
arrested  and  stored  as  glycogen  or  animal  starch.  Glyco- 
gen is  a  colloid,  and  cannot  pass  on  through  the  liver-cells 
into  the  general  blood-current.  After  each  meal  a  quan- 
tity of  this  glycogen  or  animal  starch  is  thus  stored  up. 

Now,  the  liver  has  two  blood  supplies:  the  portal  vei7i, 
which  brings  fo  it  the  albuminoids,  carbo-hydrates,  salts, 
and  water,  absorbed  by  the  bowel;  and  the  hepatic  arte- 
ry, which  conveys  to  its  cells,  for  their  nourishment,  ordi- 
nary arterial  blood.  This  latter  blood,  like  that  in  every 
artery  of  the  body,  contains  a  ferment,  diastase,  identical 
with  the  ferments  ptyalin  in  the  saliva  and  amylopsin  in 


SYMPTOMS  OF  GLUCOSUEIA.  197 

the  intestine,  and  which  has  thus  the  power  of  converting 
starch  to  grape-sugar.  Therefore,  the  liver  stores  three 
or  four  times  a  day — i.  e.,  at  each  raeal-time — a  large  sup- 
ply of  animal  starch,  and  the  branches  of  the  hepatic  arte- 
ry incessantly  convey  to  the  liver -cells,  in  which  that 
starch  is  stored,  a  small  supply  of  a  ferment  which  changes 
starch  to  sugar,  the  result  being  that  the  body,  constantly 
in  movement  of  some  kind,  and  therefore  constantly  in 
need  of  fuel,  has  incessantly  supplied  to  it  from  the  stores 
of  starch,  intermittently  laid  up  by  the  liver,  a  small,  reg- 
ulated supply  of  grape-sugar,  which  it  consumes. 

But  suppose  that,  a  very  large  amount  of  starch  and 
sugar  having  been  eaten,  an  excess  of  grape-sugar  beyond 
the  glycogenic  power  of  the  liver  should  reach  that  organ. 
What  will  ensue?  A  portion  of  such  grape-sugar  will 
pass  on  into  the  general  blood-stream,  and  we  shall  have 
an  excess  of  grape-sugar  (or  glucose)  in  the  blood,  and 
such  excess  being  beyond  the  combustion  powers  of  the 
body,  and  sugar  being  a  crystalloid,  will  pass  out  by  the 
urine — in  other  words,  we  shall  have  Glucosuria. 

It  is  evident  that  if  the  liver  be  already  debilitated  as  a 
result  of  gout  or  biliousness,  that  this  condition  of  gluco- 
suria may  ensue  on  even  a  normal  consumption  of  sugar 
and  starch. 

It  is  also  clear  that  if,  from  any  cause,  an  excess  of  ar- 
terial blood  be  conveyed  to  the  liver  by  the  hepatic  arte- 
ry, that  a  precisely  similar  state  of  matters  must  also 
ensue.  !N^ow,  in  a  certain  stage  of  kidney  degeneration, 
and  in  certain  stages  of  heart  disease,  there  is  an  increase 
of  pressure  in  the  hepatic  artery,  and,  as  the  former  of 
these  complaints  is  one  common  in  advanced  life,  we  often 
come  across  permanent  glucosuria  (^.  e.,  diabetes)  in  elderly 
people.  The  amount  of  disturbance  is,  however,  never 
great,  nor  does,  as  a  rule,  the  health  suffer  from  the  pres- 


198  DISEASES    DUE    TO    EXCESS    OF   FOOD. 

once  of  this  deraiigcment.  But,  as  a  result  of  worry, 
mental  overwork,  of  a  blow  on  the  head,  or  of  sunstroke, 
the  brain  may,  in  one  part,  undergo  degenerative  changes, 
and  if  the  part  thus  affected  be  that  whence  the  nerves 
which  control  the  hepatic  circulation  in  the  liver  issue, 
there  will  be  a  permanent  and  gross  over-supply  of  hepatic 
blood,  and  permanent  glucosuria  (i.  e.,  Organic  Diabetes) 
of  a  generally  intractable  kind  will  be  established.  This 
derangement  may  occur  at  any  age,  and  is  the  only  form 
of  glucosuria  that  need  be  dreaded. 

But  what  must  be  the  consequences  of  much  free  grape- 
sugar  in  the  general  circulation  ?  The  sugar  will  rob  the 
blood  of  much  of  its  water  and  travel  out  by  the  kidney, 
carrying  that  element  awaj'',  hence  Glucosuria  induces 
thirst,  dryness  of  the  skin  and  of  the  mouth,  dryness  of 
the  lining  inemhrane  of  the  howel^or  constipation  and  the 
2Ktssiny  of  kn'ye  quantities  of  sugar-laden  water.  Insa- 
tiable hunger  is  a  further  symptom,  for  within  a  short 
time  of  each  meal  the  glycogen  store  is  exhausted,  and 
the  body  demands  more  fuel. 

A  host  of  secondary  symptoms  may  follow  :  coldness  of 
the  extremities,  double  soft  cataract,  great  debility,  loss  of 
flesh,  muscidar  weakness,  rheumatic  pains,  sp>onginess  of 
the  gums,  a  chloroform-like  smell  of  the  breath,  etc.  Not 
unfrequently,  as  in  gout  and  biliousness,  nervous  disorders 
become  prominent  in  the  course  of  glucosuria,  and  many 
derangements  shmdating,  often  closely,  locomotor  ata.ria, 
epilepsy,  apojylexy,  etc.,  may  manifest  themselves  and  ex- 
cite unnecessary  alarm. 

It  must,  however,  be  distinctly  understood  that  none  of 
the  symptoms  I  have  enumerated  exist,  to  an  extensive  or 
alarming  degree,  in  ordinary  glucosuria,  the  result  of 
mere  overfeeding  or  of  temporary  over -pressure  in  the 
hepatic  artery,  but  are  only  the  consequences  of  perma- 


TREATMENT  FOR  GLUCOSURIA.  199 

nent  glucosuria  (i.  6.,  organic  diabetes),  taking  its  origin 
in  brain  degeneration. 

The  appearance  of  sugar  in  the  urine  of  those  who  con- 
sume large  quantities  of  sugar  or  starch  is  a  distinct  ben- 
efit; the  kidney,  acting  as  a  safety-valve,  ridding  the  body 
of  such  excess.  In  gouty  and  bilious  people  glucosuria  is 
commonly  witnessed  even  in  the  absence  of  any  noticeable 
excess,  and  means  only  that  the  liver's  functions  generally 
are  impaired.* 

In  every  ten  cases  of  so-called  diabetes  that  have  pre- 
sented themselves  to  me,  nine  have  been  sufferers  from  a 
temporary,  and  under  the  circumstances  beneficial,  gluco- 
suria, and  their  worst  symptoms  the  consequences  either 
of  unwarranted  fear  or  of  absurd  dietetic  restrictions,  not 
only  unnecessary  in  their  cases,  but  positively  harmful,  f 

The  sole  treatment  for  glucosuria,  when  it  is  not  asso- 
ciated with  brain  disease  (and  this  latter  form  of  the  com- 
plaint does  not  here  concern  us),  is  to  cut  down  somewhat 
the  supply  of  starch  and  sugar.  Never,  in  these  cases, 
should  we  forbid  entirely  starch  and  sugar  and  recommend 
only  diabetic  food;  it  is  absolutely  unnecessary,  and,  in 
almost  every  case,  most  dangerous  ;  not  one  constitution 
in  twenty  can  stand  such  a  sudden  and  radical  dietetic 
change.  It  is  entirely  fallacious  to  argue  that  because  the 
Esquimaux  and  the  Guachos  can  maintain  on  meat  and 

*  The  permanent  form  of  glucosuria  due  to  nerve  degeneration  is 
nearly  always  accompanied  by  the  passage  from  the  kidney  of  an 
excess  of  urea. 

f  It  is  an  extraordinary  fact  that  there  exist  even  young  people 
who  pass  regularly  large  quantities  of  urine  containing  much  grape- 
sugar,  and  who,  nevertheless,  remain  in  perfect  health.  I  know  at 
present  of  one  gentleman,  under  thirty  years  of  age,  who  has  been 
over  and  over  again  rejected  by  insurance  societies  on  this  score, 
and  who  yet,  after  five  or  six  years,  during  which  I  have  known 
him,  remains  in  absolute  health. 


200  DISEASES    DUE    TO    EXCESS    OF   FOOD. 

fat,  to  the  exclusion  of  starch  and  sugar,  necessary  health 
and  vigor,  that  therefore  the  Englishman  cannot  at  any 
rate  be  much  injured  by  such  a  dietary,  for  both  of  the 
two  former  races  have  become  very  gradually  accustomed 
to  their  mode  of  life. 

5.  The  Liver  acts  as  an  excretory  organ. — This  function 
and  its  derangement  will  demand  but  a  few  lines.  The 
liver  excretes,  mixed  with  the  ordinary  bile  constituents 
(the  bile  acid,  bile  pigment,  etc.),  several  materials  brought 
to  it  by  the  hepatic  artery.  Of  these  the  one  that  is  most 
important  in  relation  to  disease  is  cholesterin.  This  sub- 
stance, ranged  by  chemists  among  the  alcohols,  is  a  prod- 
uct of  nerve  waste,  and  is  carried  by  the  branches  of  the 
hepatic  artery  to  the  liver  for  excretion  with  the  bile. 
When,  as  a  sequence  of  any  of  the  causes  given  under  the 
head  of  biliousness  as  producers  of  an  arrested  bile  flow,  the 
bile  stagnates,  there  is  always  grave  risk  of  the  formation 
in  the  small  ducts  of  bile-sand,  some  of  which,  carried  on 
subsequently  into  the  gall-bladder,  forms  the  nuclei  there 
of  larger  concretions  which  receive  the  name  of  Gall  Stones. 
The  genesis  of  a  gall  stone  is  the  same  as  that  of  a  gouty 
stone  in  the  kidney,  but  the  constitution  of  each  is  very 
different,  the  former  consisting  of  cholesterin,  earthy 
salts,  biliary  and  fatty  acids,  etc.;  the  latter  of  uric  acid 
or  of  urates. 

The  gall-bladder,  unfortunately,  like  the  urinary  bladder 
into  which  a  uric-acid  stone  generally  finds  its  way  from 
the  kidney,  forms  a  convenient  resting-place  for  a  gall 
stone,  and  one  from  which  it  is  difficult  to  dislodge  it  by 
any  short  of  surgical  means.  It  may,  however,  as  a  re- 
sult of  some  sudden  effort  on  the  part  of  the  patient,  or 
even  without  this,  enter  the  large  bile  duct  and  be  forced 
onward,  by  the  spasm  it  therein  sets  up,  to  the  bowel. 
This  process  may  last  for  minutes  or  for  days,  and  be  at- 


THE    TREATMENT    OF    GALL    STONES.  201 

tended  by  jaundice  or  not  so  attended.  It  usually  gives 
rise  to  the  most  sudden  and  excruciating  pain,  but  many 
stones,  even  of  fair  size,  may  thus  be  passed  with  nothing 
but  trivial  discomfort,  or  even  without  any  such  sensation 
at  all.  It  is  no  unfrequent  thing  for  pathologists  to  find 
several  of  such  stones,  lying  loose  in  the  intestines  of  persons 
who  never  complained  of  a  single  symptom,  even  remotely 
referable  to  their  presence  in,  or  their  passage  along,  the 
bile  duct. 

77^6  treatment  0/  Gall  Stones  is  the  same  as  that  for 
chronic  biliousness,  of  which  indeed  it  ranks  but  as  a 
symptom.  The  dietary  should  consist  largely  of  fruit  and 
vegetables,  and  of  water  and  other  bland  fluids.  Every 
means  conducing  to  the  general  health  of  the  body  should 
be  studiously  pursued. 

A  visit  to  the  waters  of  Carlsbad,  Vichy,  and  Ems  is 
often  of  service,  more  perhaps  as  leading  to  the  consump- 
tion of  large  quantities  of  saline  fluid  (and  both  salt  and 
water  are  to  be  reckoned  as  bile  diluents)  than  for  any 
special  virtue  resident  in  the  waters. 

The  salicylates,  owing  to  their  action  as  potent  bile 
stimulants  and  their  power  of  increasing  especially  the 
watery  constituents  of  bile,  have  been  recommended,  and 
their  use  is  indicated  in  cases  vrhere  the  presence  of  bile- 
sand  or  bile-gravel  in  the  smaller  bile  ducts  is  reasonably 
to  be  suspected,  but  their  power  over  the  liver,  like  that 
of  all  stimulants,  is  soon  lost  and  replaced  by  an  after  and 
counter  effect — i.  e.,  a  reaction;  and  this  drawback,  in  ad- 
dition to  the  irritating  properties  of  these  compounds  on 
the  kidneys,  renders  their  prolonged  use  injudicious,  and, 
in  the  long  run,  usually  anything  but  a  blessing. 

Ere  we  proceed,  one  or  two  points  will  require  some 
elucidation.  I  have  said  that  Gout,  Biliousness,  Rheuma- 
tism, Glucosuria,  and  Gall  Stone  are  derangements  often 
9* 


202  DISEASES    DUE    TO   EXCESS    OF   FOOD. 

due  to  simple  over-feeding,  to  the  consumption  of  food  in 
excess  of  the  digestive  faculties.  How  then  comes  it, 
may  ask  the  reader,  that  these  complaints  occur,  as  a  rule, 
singly,  and  that  a  combination  of  them  is  seldom  wit- 
nessed in  the  one  naan,  whatever  be  his  dietetic  mistakes  ? 
The  answer  is  simple.  That  function  of  the  liver,  which, 
by  reason  of  the  influence  of  heredity,  or  the  stress  of  cir- 
cumstances special  to  the  case,  is  the  first  to  break  down, 
brings  in  its  train  symptoms  which  compel  the  patient, 
temporarily  at  all  events,  to  exercise  great  frugality. 
How  is  the  dyspej^tic,  for  dyspepsia  is  but  one  of  the 
many  secondary  signs  of  gout,  etc.,  to  be  a  glutton  ?  The 
very  difliculty  of  digestion,  be  it  remarked,  is  here  seen 
in  its  true  aspect,  that  of  a  benefit,  saving  the  sufferer 
from  further  evil,  and  even  from  death.  Nevertheless,  all 
the  failures  of  the  liver  may  be  seen,  though  not  often 
simultaneously,  in  the  one  sufferer.  Up  to  middle  life 
biliousness  will  probably  be  the  sole  manifestation  of  de- 
rangement, and  this  may  be  accompanied  by  the  forma- 
tion of  gall  stones.  In  middle  life  gout  will  take  up  the 
running,  arresting  or  lessening,  by  the  restrictions  it  im- 
poses on  the  food,  the  course  of  the  complaint  which  pre- 
ceded it.  Glucosuria  may  appear  a  little  later,  for  it  is  a 
frequent  accompaniment  of  gout,  and  rheumatism,  or  what 
would  pass  as  rheumatism  in  a  non-gouty  subject,  will  al- 
most, for  a  certainty,  be  soon  added  to  the  list  of  com- 
plaints. Towards  the  end  of  life  Briglit's  disease  of  the 
kidney  will  not  improbably  establish  itself,  and  with  it, 
some  authorities  think  consequently  on  it,  degeneration 
of  the  arteries  and  valvular  disease  of  the  heart  will  put 
in  an  api)earance,  which  conditions  render  the  glucosuria, 
at  first  intermittent  and  slight,  permanent  and  trouble- 
some. Such  is  the  simple  sequence  of  misfortunes,  all  de- 
rived from  the  one  source,  liver  failure,  whicli  go  to  make 


THE    CONSEQUENCES    OF   EXCESS.  203 

up  "the  complicrttion  of  diseases"  from  which  a  patient 
declares  himself  to  be  suffering,  nor  is  it  to  be  wondered 
at  that  the  sufferer  should  be  perplexed  at  the  multiplicity 
of  his  troubles,  when  we  remember  that  each  degeneration 
again  induces  a  secondary  set  of  further  derangements  in 
the  eyes,  the  ears,  the  bladder,  the  skin — in  fact,  alt  over 
the  frame. 

Passing  now  from  our  contemplation  of  the  results  of 
excess  as  witnessed  in  the  liver,  that  great  janitor  placed 
at  the  portals  of  the  circulation,  let  us  briefly  discuss  the 
consequences  of  excess  as  they  appear  in  the  blood-stream 
and  in  the  cells  to  which  it  is  borne. 

As  regards  albumen,  an  excess  in  this,  the  only  real 
cell-food,  means,  as  I  have  already  said — for  we  have  had 
to  pursue  the  consequences  of  gout  and  of  rheumatism 
beyond  their  fount,  the  liver — a  slow  degeneration  of  the 
kidneys,  arteries,  and  heart.  In  fact,  the  one  word  degen- 
eration covers  the  very  long  and  formidable  list  of  de- 
rangements which  "  as  the  night  the  day  "  must  follow  in 
the  wake  of  an  over-supply  of  albumen.  Each  cell  in  the 
human  body,  be  it  in  a  solid  organ  such  as  the  liver,  kid- 
ney, or  brain,  or  in  a  hollow  one,  such  as  a  blood-vessel  or 
other  channel,  possesses  but  a  certain  store  of  energy, 
which  must,  by  the  processes  of  life,  be  eventually  ex- 
hausted in  any  case,  and  which  may  be  either  made  by 
economy  to  suffice  lor  what  we  call  a  prolonged  and 
healthy  life,  or,  by  over-stimulation  or  other  misuse,  be 
brought  to  premature  failure.  The  so-called  evils  of  ad- 
vancinor  aore,  which  show  themselves  in  some  when  the 
meridian  of  life  is,  judging  by  years  only,  scarcely  passed, 
are  not  the  necessary  accompaniments  of  age,  but  merely 
the  signs  and  evidences  of  an  ignorant  misuse  of  the  body, 
weak  perhaps  also  from  the  time  of  conception,  as  a  re- 
sult of  imperfect  parents.     If  men  were  bred  like  domes- 


204  DISEASES    DUE  TO    EXCESS    OF   FOOD. 

tic  auimals,  with  a  main  view  to  the  duties  which  each  is 
expected  to  fulfil  in  life,  and  if  the  elementary  laws  of  phys- 
iology were  understood  and  followed,  disease,  except  as 
the  result  of  mechanical  violence,  would  be  almost  un- 
known.  The  breeding,  training,  and  rearing  of  the  race- 
horse are  entirely  different  from  that  of  the  farm  steed, 
and,  as  a  result,  the  ends  to  be  secured,  in  the  first  case 
speed,  in  the  second  strength,  are  usually  obtained;  and 
if  hygiene  is  ever  to  command  the  respect  and  the  grati- 
tude of  the  human  race,  it  must  teach,  in  regard  to  man, 
the  same  principles,  and  not  the  absurd  and  utterly  un- 
scientific "one  standard  for  all"  doctrine.  What  are 
nine  tenths  of  the  derangements  for  which  man  seeks 
relief  due  to,  but  to  the  unwise  attempts  to  accommodate 
a  body,  well  fitted  only  for  certain  conditions  to  others, 
to  which  it  evidently  is  not  so  fitted,  and  with  which  it  is 
ever,  as  witnessed  by  its  derangements,  seeking  a  modus 
Vivendi.  Fortunately  for  mankind,  functional  disease  oft- 
en steps  in  between  him  and  his  latter  end,  and  prolongs 
a  life  which  otherwise  must  be  in  many  cases  exceedingly 
brief. 

An  excess  in  the  consumption  of  the  fuel-foods — ^.  e.,  the 
fats,  starches,  and  sugars — over  and  above  the  combustion 
power — ^.  e.,  the  oxygen  supply  of  the  body — leads  to  the 
one  great  evil  Obesity,  which  again  brings  in  its  train  many 
secondary  and  grave  derangements. 

The  subject  of  corpulence  being  in  many  ways  an  im- 
portant and  interesting  study,  we  may  profitably  inspect 
the  subject  a  little  closely.     First,  as  to  its  causation  : 

Excessive  eating^  if  the  primary  digestion  remains  good, 
will  naturally  rank  first  among  causes,  nor  need  this  excess 
be  confined  to  the  fuel-foods,  for  albumen,  and  perhaps 
every  substance  that  is  capable  of  being  absorbed  by  the 
stomacli  and  bowel,  except  water  and  such  compounds  as 


THE    CAUSES    OF    OBESITY.  205 

are  of  the  nature  of  inorganic  salts,  undergo  some  oxida- 
tion in  the  body  and  therefore  draw  on  the  oxygen  supply 
available  for  the  fuel-foods.  Alcohol  is  a  notable  member 
of  tlie  latter  class,  and  while  itself  an  indiiferent  and  singu- 
larly inconvenient  food,  it  economizes  the  consumption  of 
fuel-foods,  and  may,  therefore,  spite  of  its  many  great  draw- 
backs, be  sometimes  useful  as  an  adjunct  in  the  treatment 
of  wasting  complaints.  Alcohol  drinking  is,  therefore,  also 
a  common  cause  of  obesity. 

It  is  clear,  moreover,  that  any  decrease  in  the  necessary 
oxygen  supply  will  tend  also  to  the  production  of  corpu- 
lence. Want  of  exercise  and  habits  of  indolence  become, 
therefore,  other  things  being  equal,  decided  fatteners. 
The  air  of  valleys,  especially  if  somewhat  moist,  will,  by 
its  comparative  poorness  in  oxygen,  favor  the  process.  If 
the  red-hlood  corpuscles  of  the  hlood,  the  oxygen  carriers,  he 
deficient  in  quantity,  a  state  of  matters  often  seen  in  anae- 
mia, especially  in  that  form  of  it  common  in  young  peo- 
ple, and  which  is  unconnected  with  organic  disease,  there 
will  be  observed  a  remarkable  tendency  to  plumpness, 
often  a  very  puzzling  symptom  to  the  friends  of  the  pa- 
tient.* 

It  also  stands  to  reason  that  if  loss  of  bodily  heat  by 
radiation  can  be  minimized,  there  will  be  a  tendency  rather 
to  the  deposit  of  fuel-foods  in  the  body  in  the  form  of 
fat,  than  to  their  complete  combustion.  Flannel  clothing 
worn  next  the  skin,  and  a  warm,  moist  temperature,  are 
therefore  entitled  to  rank  as  indirect  agents  in  increasing 
bodily  weight. 

The  sexual  system  exercises  a  potent,  though  obscure, 
influence  on  corpulency.     Torpor  of  it  is  marked  by  a  dis- 

*  Drs.  Vulpian  and  Dechambre  have  proved  incontrovertibly  that 
an  increase  of  weight  is  the  result  of  bleeding  in  healthy  people. 


206  DISEASES    DUE    TO    EXCESS    OF    FOOD. 

tinct  increase  of  weight,  while  undue  activity  is  attended 
by  the  opposite  condition.  To  this  fact  is  due  the  ten- 
dency to  corpulence  so  often  observed  in  women  after  the 
climacteric,  and  many  of  the  more  or  less  sudden  varia- 
tions in  weight  in  both  sexes.  Unsexed  animals  fatten 
with  greater  readiness  than  do  others,  when  placed  under 
similar  conditions  of  life.  Finally,  heredity  in  this,  as  in 
all  other  complaints,  is  often  a  potent  predisposing  cause. 

As  to  the  treatment  of  obesity,  much  has  been  written. 
I  need  scarcely  caution  my  readers  against  each  and  every 
system  that  depends,  mainly  or  solely,  upon  the  adminis- 
tration of  a  drug,  without  distinction  of  persons,  for  its  re- 
sults. All  noxious  drugs  will  decrease  the  bodily  weight 
of  those  who  are  foolish  enough  to  take  them  systemati- 
cally, by  their  interference  with  the  processes  of  healthy 
nutrition.  Some,  of  which  solution  of  potass  is  an  ex- 
ample, acting  more  or  less  in  a  local  manner,  disorder  the 
lining  membranes  of  the  stomach  and  bowels,  and  thus 
arrest  digestion,  though  this  malign  effect,  being  slow  in 
operation,  often  escapes  the  notice  of  the  patient,  till  he 
finds  himself,  perhaps  suddenly,  the  victim  of  incurable 
dyspejjsia  (chronic  gastric  and  intestinal  catarrh) ;  other 
drugs  again,  of  which  order  are  the  stronger  acids — vine- 
gar, sulphuric  acid,  etc. — act  in  a  similar  way,  and,  when 
consumed  with  or  just  after  a  meal,  interfere  also  directly 
with  the  digestibility  of  the  food. 

A  third  variety  of  drug  depends  mainly  for  success  upon 
its  purgative  action;  of  such  many  of  the  purgative  saline 
waters,  especially  those  of  Carlsbad,  Marienbad,  Brides, 
and  Piillna,  are  good  examples.  Objectionable  as  sole 
agents  of  cure,  they  are  often  admissible  as  adjuncts  in  a 
more  extensive  and  physiological  treatment. 

My  advice  to  the  corpulent  is  as  follows  :  Go  first  to  a 
doctor  and  ascertain  if  you  require  treatment,  if  your  state 


TREATMENT    OF    CORPULENCE.  207 

is  one  that  will  be  benefited  by  a  reduction  in  weight.  The 
majority  of  those  demanding  treatment  are  not  fit  subjects 
for  it.  In  many,  especially  in  those  of  the  female  sex,  the 
increase  of  weight  is  only  temporary  and  does  not  involve, 
even  if  permanent,  any  ultimate  danger;  on  others,  again, 
heredity  has  set  its  seal  so  strongly  that  no  means,  short 
of  those  dangerous  to  life,  would  have  any  chance  of  suc- 
cess. The  decision  in  every  case  must  rest  with  the  phy- 
sician, and  to  him  also  must,  in  nearly  every  instance,  the 
selection  of  the  line  of  treatment  be  left.  Of  such,  omit- 
ting the  very  doubtful  cures  by  balneo-therapy,  electricity, 
milk  diet,  mineral  waters,  and  drugs  generally,  there  are 
four  which  deserve  attention.  They  are  those  of  Banting, 
of  Ebstein,  of  See,  and  of  QErtel-Sweininger. 

That  of  Banting  may  be  briefly  dismissed.  It  recom- 
mended a  relative  excess  of  meat  and  a  deficiency  of  fruit 
and  vegetables.  This  mistake  often  led  to  severe  dys- 
pepsia and  always  to  a  considerable,  and  sometimes  to  a 
dangerous,  loss  of  strength.  The  stomach,  moreover,  re- 
belled against  the  sameness  of  the  dietary. 

The  system  of  Ehstein  is  founded  on  surer  ground.  He 
teaches,  with  perfect  correctness,  that  an  excess,  even  of 
albumen,  leads  to  corpulency,  and  therefore  he  relies  npon 
a  general  all  round  reduction,  rather  than,  as  did  Banting, 
on  a  diminution  in  the  fats  and  starches  only.  He  recom- 
mends also,  with  great  wisdom,  a  gradual,  and  not  a  sud- 
den, restriction  in  food. 

Ebstein  generally  fixes  his  zero  of  diet  at  about  3^  oz.  of 
albumen,  1^  oz.  of  starch  or  sugar,  and  2f  oz.  of  fat.  He 
limits,  moreover,  the  choice  of  fat  consumed  to  butter  or 
lard,  which  are,  among  fats,  the  most  easy  of  digestion. 
He  restricts  to  the  lowest  point  the  drinking  of  fluids,  but 
allows  light  white  wine  as  a  beverage. 

Dr.  Germain  See,  while  adopting  in  general  the  system 


208  DISEASES    DUE    TO    EXCESS    OF    FOOD. 

ofEhstein,  adds  gelatinous  substances  to  the  regimen,  and 
allows  an  abundance  of  fluid  (in  this  particular  differing 
from  all  his  rivals),  while  forbidding  alcoholic  drinks,  es- 
pecially banning  malt  liquor  in  every  form.  He  recom- 
mends coffee  and  tea  in  abundance,  holding  that  in  largo 
doses  their  action  is  to  aid  denutrition,  but  that  in  small 
doses  they  possess  an  opposite  effect.  He  believes  in  the  effi- 
cacy of  certain  drugs,  notably  of  iodide  of  potassium,  espe- 
cially if  the  heart  be  much  oppressed  by  the  weight  of  fat. 

The  (Ertel-Sweininger  system  is,  to  my  mind,  of  all  the 
most  rational,  complete,  and  safe,  as  certainly  it  is  the  most 
generally  successful,  of  any.  This  treatment  includes  a 
more  thorough  preliminary  study  of  each  special  case  than 
is  accorded  under  any  other  system.  Two  great  classes, 
subject  to  many  subdivisions,  are  recognized  by  it.  The 
first  class  comprises  those  whose  hearts  have  been  already 
affected  by  the  adipose  deposit,  the  second  all  not  thus  af- 
fected. For  the  former,  cautious  and  gradually  increased 
exercise,  a  somewhat  liberal  allowance  of  meat,  and  often  a 
ferruginous  tonic,  is  the  line  of  cure;  for  the  latter,  forced 
exercise  —  especially  mountain-climbing  —  and  a  more  re- 
stricted meat  allowance  are  recommended. 

The  diet  scale  is  a  much  more  liberal  one  than  that  of 
Ebstein,  and,  while  Drs.  Q^rtel  and  Sweininger  believe  that 
restrictions  in  the  quantity  of  fluid  consumed  have  both  a 
sure  effect  in  reducing  bodily  weight,  and  a  beneficial  ac- 
tion in  lessening  the  strain  thrown  on  the  fatty  heart,  their 
fluid  allowance  to  the  patient  is,  on  the  whole,  much  fuller 
than  that  of  Ebstein,  but  the  ingestion  of  fluid  during  a 
meal  is  strictly  forbidden. 

About  5  oz.  of  albumen,  3  oz.  of  starch  or  sugar,  and  1-^^ 
oz.  of  fat  represent  the  mean  diet  under  this  latter  cure, 
for  the  carrying  out  of  which  Dr.  (Ertel  keeps  a  special 
establishment. 


TREATMENT    OF    CORPULENCE.  209 

Such  is  a  brief  outline  of  tlie  most  reliable  systems  for 
the  reduction  of  cor^^ulency,  and  of  the  three — for  Bant- 
ingism  is  to  all  intents  and  purposes  dead — the  last-men- 
tioned, that  which  usually  passes  as  CErtel's,  is  to  be  pre- 
ferred, as  founded  on  the  surest  principles,  and  carried  out 
according  to  the  special  requirements  of  each  individual 
case.  It  is,  however,  expensive,  for  it  involves  residence 
at  Dr.  CErtel's  establishment  for  some  weeks,  and  this  at 
once  places  it  out  of  the  reach  of  the  majority  of  suf- 
ferers. 

As  to  home  treatment,  if  the  doctor's  opinion  be  favor- 
able as  regards  the  vigor  of  the  heart,  and  if  the  case  be 
one  likely  to  benefit  the  general  health  by  the  reduction 
of  weight,  the  best  way  to  insure  the  desired  end  is  as 
follows  : 

(a)  Gfadually  reduce  the  dietary,  hxxt  in  no  case  let  tbe 
daily  amount  fall  below  5  oz.  of  albuminous  food,  lean 
meat  or  fish,  etc.,  1-J  oz.  of  fat,  chiefly  butter,  and  4  oz.  of 
sugar  or  starchy  material. 

To  this  may  be  added  per  diem  from  |-  to  f  lb.  of  ripe 
fruit,  except  grapes,  figs,  dates,  and  nuts,  and  at  least  ^  lb. 
of  watercress,  parsley,  celery,  cucumber,  cabbage,  kale,  tur- 
nips, or  asparagus. 

ip)  Drink  sparingly,  and  of  water,  coffee,  or  tea  only, 
and  never  within  one  hour  of  a  meal  nor  at  mealtimes. 

(c)  Take  gradually  such  exercise  as  loill  induce  free  per- 
spiration, and  deep  indraughts  of  pure  air.  Lawn-tennis, 
cricket,  football,  cycling,  and  riding  are  the  best  forms. 

{d)  Bathe  frequently,  a  hot  bath  twice  a  week,  a  Turk- 
ish bath  once  a  month,  and  a  cold  douche  each  morning. 

(e)  Take,  if  the  above  means  do  not  suffice,  an  occasional 
dose  of  Piillna,  Carlsbad,  Friedrichshall,  Vichy,  or  other 
purgative  mineral  water  ;  or  even,  if  all  measures  fail,  a 
morning  and  evening  dose  of  iodide  of  potassium  or  of 


210  DISEASES    DUE    TO    EXCESS    OF    FOOD. 

iodide  of  sodium  in  one  of  the  forms  to  be  found  in  the 
Appendix  (Formulas  2  and  3).  They  are,  at  any  rate,  the 
least  noxious  of  the  long  list  of  medicaments  which  pos- 
sess, among  other  properties,  that  of  reducing  weight. 

Summary  of  Chapter. 

Let  us  try  to  take  up,  in  one  coup  cVceil,  all  the  results 
of  excess  we  have  mentioned,  and  some  less  important  ones 
that  require  but  few  words. 

When  the  amount  of  food  consumed  is  in  excess  of  the 
bodily  requirements,  there  will,  of  necessity,  appear  in 
varying  severity  and  in  a  variable  period — both  of  which 
are  dependent  on  the  age,  strength,  and  habits  of  the  in- 
dividual, and  the  amount,  nature,  and  frequency  of  the 
excess — two  sets  of  symptoms. 

The  first,  those  of  functional  disorder,  of  a  corrective 
and  curr.tive  nature,  and  due  to  the  rebound  of  the  body, 
to  use  a  figurative  but  expressive  simile,  from  adverse  con- 
ditions. 

The  second,  those  of  degeneration,  of  premature,  more 
or  less  local,  death,  due  to  exhaustion  of  the  vitality  resi- 
dent in  the  outworked  organs. 

The  evidences  of  the  first  set — i.  e.,  of  beneficial  func- 
tional disorders,  are  : 

1.  In  the  aliinentary  tracJc :  Dyspepsia,  with  its  host  of 
well-known  primary  phenomena,  loss  of  appetite,  distaste^ 
irregularity  of  bowels,  flatulence,  and  jt9«^?^. 

2.  Commencing  in  the  liver  and  thus  affecting,  through 
the  blood-stream,  more  or  less  the  whole  body :  Gout,  Bil- 
iousness, Rheumatism,  Glucosuria,  and  Gall  Stone. 

3.  llestricted  to  the  tissues :  Corpulence. 

The  secondary,  final,  degenerative  symptoms  are  as  fol- 
lows : 

1.  In  the  alimentary  tracTc. — As  a  result  of  the  persist- 


SUMMARY    OF    CHAPTER.  211 

cnce  of  the  causes  which  have  led  to  the  dyspepsia  {not  as 
a  result  of  repeated  attacks  of  dyspepsia). 

Premature  debility,  due  to  structural  change,  in  the 
whole  alimentary  track,  and  marked,  in  the  mouth,  by  per- 
manent changes  in  the  lining  membranes  and  the  salivary 
glands,  and  hence  in  the  saliva,  and  in  decay  of  the  teeth  ; 
in  the  stomach,  by  permanent  alteration  in  its  walls,  with 
a  lasting  impairment  of  its  digestive  fluid,  and  of  its 
muscular  contracting  power  ;  in  the  intestines,  by  changes 
similar  to  those  in  the  stomach. 

All  of  which  lead  to  a  permanent,  all  round  impairment 
of  the  digestive  faculty;  the  sufferer  possessing  a  condi- 
tion of  the  digestive  organs  named  proper  to  a  man  much 
more  advanced  in  years. 

2.  In  the  liver. — A  premature  and  inveterate  debility 
characterizes  also  the  functions  of  the  liver.  The  poisons 
of  gout,  biliousness,  rheumatism,  and  glucosuria  are  no 
longer  intermittently,  but  regularly,  poured  into  the 
blood,  and  the  formation  of  gall-stones  advances.  The 
liver  structure  itself  becomes  altered,  the  cells  begin  to 
disappear,  strangled  by  increasing  fibrous  material. 

3.  On  the  tissues  falls  also  a  very  heavy  strain.  The 
eliminating  organs,  the  kidneys  especially,  but  also  the 
skin  and  lungs,  are  systematically  overworked  in  trying 
to  cope  with  the  ever-increasing  quantity  of  poisonous 
material  in  the  blood-stream,  and  therefore,  sooner  or 
later,  their  failure  comes. 

{a)  In  the  kidney  such  failure  is  known  either  as  con- 
tracted kidney,  a  form  of  Bright's  Disease  of  an  incurable 
kind,  or  takes  the  shape  of  cystic  or  even  suppurative  de- 
struction. 

{h)  In  the  lung,  Chronic  Bronchitis  and  one  variety  of 
Chronic  Asthma  are  the  commonest  complaints,  but  more 
deeply  seated  evil  may  appear,  especially  a  form  of  change 


212  DISEASES    DUE   TO    EXCESS    OF    FOOD. 

similar  to  that  seen  in  the  kidney  and  liver,  a  growth  and 
subsequent  contraction  of  the  fibrous  material,  leading  to 
a  form  of  cojisumption  not  unfrequent  in  the  victims  of 
excess,  and  known  as  Fibroid  Phthisis. 

(c)  In  the  skin.  Chronic  Eczema  and  Chronic  Psoriasis  are 
the  commonest  evidences  of  failure  of  the  skin  functions. 

But  the  breakdown  of  the  kidneys  from  its  first  com- 
mencement, and  often  years  before  it  can  be  diagnosed  by 
the  aid  of  science,  sets  up  a  train  of  further  symptoms. 
On  them  falls  naturally  the  duty  of  ridding  the  body  of 
those  very  poisonous  nitrogenous  debris,  urea  and  uric  acid, 
which,  in  health,  are  always  being  rapidly  eliminated  by 
them.  Not  only,  then,  from  the  first  moment  of  failure, 
do  the  poisonous  products  of  mal-digestion  and  mal-assimi- 
lation  accumulate,  but  also  the  natural,  but,  if  retained, 
deleterious,  products  of  the  normal  disintegration  of  tissfie 
collect  in  the  body,  aggravating  the  existing  evils  and  set- 
ting new  evils  in  action.  The  blood-stream  is  not  only 
vitiated,  but,  as  elimination  fails,  the  blood-pressure  rises, 
and  the  overstrained  coats  of  the  arteries  and  the  heart  it- 
self, begin  to  undergo  retrograde  change.  Everywhere  is 
disorder;  life  may  flicker  on  for  long,  if,  under  the  direc- 
tion of  skilful  men  who  comprehend  the  whole  situation, 
wise  means  are  adopted  to  economize  what  remains  of 
vitality,  for  a  single  adverse  condition  may  suflice  to  ex- 
tinguish it  forever. 

Wliat  a  terrible  picture  of  final  disorder,  the  reader  ex- 
claims. There  is  nothing  terrible,  and  there  is  certainly 
nothing  disorderly,  in  such  a  sequence  of  events.  Each 
effect  is  the  well-ordered  and  inevitable  result  of  an  ade- 
quate cause.  The  individual  started  life  with  a  certain 
capital  of  vitality,  unevenly  distributed  perhaps,  thanks 
to  the  folly,  vice,  or  misfortune  of  his  forefathers,  among 
the  various  organs  of  liis  body,  and  he  made  no  attempt 


SUMMARY    OF    CHAPTEK.  213 

to  Study  the  various  dispositions  of  this  vitality.  The 
modes  of  life  of  more  robust  or  differently  constituted  in- 
dividuals he  copied,  and  his  weaker  organs  gave  out,  while 
the  stronger  ones  broke  down  under  the  additional  strain 
thus  thrown  on  them,  and  then,  in  the  words  of  Edgar 
Allen  Poe,  "unmerciful  disaster  followed  fast  and  fol- 
lowed faster,"  aggravated  probably  by  misdirected  ef- 
forts, the  result  of  misinterpreted  symptoms.  The  ^^oint 
of  view,  the  human  one,  from  which  we  regard  the  scene, 
misleads  us;  how  shall  we  view  as  beautiful,  as  dispas- 
sionately well  ordered,  that  which  robs  us  of  a  relation,  a 
friend,  or  even  a  fellow-man,  and  yet  the  same  laws  of 
Nature  by  which  alone  what  is,  is,  are  here  working  as 
regularly,  as  orderly,  as  precisely,  as  in  the  building  up  of 
a  race  or  the  blooming  of  a  beautiful  flower. 

But  a  truce  to  sentiment :  the  practical  question  of 
treatment  confronts  us. 

Let  each  individual  early  in  life  study  his  own  body  and 
its  special  disposition  of  forces.  For  this  no  abstruse  de- 
tails, no  higher  mathematics,  nothing  but  a  simple  book 
on  elementary  physiology,  a  little  common-sense,  and  a 
little  study  of  his  family  history  in  its  bearing  especially 
on  family  weaknesses  are  required. 

Thus  may  each  one  come  to  a  real  physical  knowledge 
of  himself,  of  his  wants,  of  his  possibilities,  and,  finally, 
of  his  likely  dangers.  To  be  forwarned  is  to  be  fore- 
armed. 

When,  within  that  kingdom  of  cells  which  he  rules,  man 
hears  the  mutterings  of  discontent,  or  feels  the  shock  of 
actual  rebellion,  let  him  be  wise,  let  him  recognize  that 
he  has  oppressed,  over-taxed,  some  portion  of  his  people, 
and  let  him  proceed  without  loss  of  time  to  a  redress  of 
grievances  and  to  a  permanent  and  necessary  reform  of 
his  mode  of  government.     From  apparent,  disguised  evil 


214  DISEASES    DUE    TO    EXCESS    OF    FOOD. 

will  thus  come  good;  from  temporary  commotion,  a  more 
lasting  peace. 

But  even  if  matters  have  reached  a  desperate  pass;  if, 
as  a  result  of  inheritance  or  of  years  of  misgovernment, 
tlie  kingdom  is  eaten  through  and  through  with  discon- 
tent, is  wasted  by  famine  or  other  disaster,  so  that  no  re- 
form, no  redress  of  existing  grievances,  can  now  undo  the 
mischief,  even  then  much  may  be  done  by  management, 
by  care,  by  knowledge,  and  by  tact. 

The  dietary  cannot  be  cut  down  to  the  low  level  of  di- 
gestive power;  then  let  it  be  cut  down  as  low  as  it  safely 
can.  Apply  the  pruning-hook  of  surgery  or  of  medicine 
where  it  will  suffice  to  cast  off  useless  and  troublesome 
members,  so  that  the  essence  of  life  may  be  economized 
for  the  still  useful  members  of  this  country  of  man.  But 
he  who  is  wise  in  time,  he  who  will  order  his  life  wisely 
and  temperately,  need  not  anticipate  trouble,  for  it  will 
probably  never  touch  him.  For  him  the  science  of  medi- 
cine will  exist  as  a  friend  and  counsellor,  never  as  an 
almost  impotent  ally  in  the  dread  struggle  for  the  last 
remnant  of  a  miserable  life. 

The  physician  does  not  carry  with  him  any  essence  of 
life  that  he  can  give  away  to  the  prodigal,  bankrupt  in 
vitality,  nor  do  any  of  his  drugs  possess  one  conceivable 
fraction  thereof;  he  carries  with  him  but  one  gift  that  he 
can  impart  to  the  sufferer,  knowledge  of  human  structure 
and  human  powers,  with  whicli  charts  of  tlie  calmer,  safer 
waters  of  life  may  be  constructed. 


CHAPTEE  IX. 

DISEASES  DUE  TO  UNSUITABLE  FOOD. 


I.  Foods  absolutely  unfit  for  all  men. 

The  flesh  of  animals  that  have  given  lodgment  to  such  parasites 
as  tape-worm  and  trichina,  or  that  have  died  of  certain  febrile 
diseases,  or  that  have  been  dosed  with  such  drugs  as  arsenic 
and  antimony. 

Decomposing  meat. 

Meal  made  from  blighted  wheat,  barley,  or  rye,  or  that  in  the 
process  of  grinding  has  become  contaminated  by  lead,  etc. 

Water  containing  certain  soluble  salts,  especially  oxide  of  lead,  or 
that  contaminated  by  decomposing  animal  products. 

II.  Foods  unfit  for  some  men. 

Fat  when  hot,  or  when  mixed  with 
condiments,  etc. ,  as  in  ragouts. 

Fat(e.  g.,  butter  or  lard)  intimately  com- 
pounded with  flour  and  sugar,  as  in 
pastry,  sweet  cakes,  etc. 

Fat  becoming  at  all  rancid. 

Imperfectly  cooked  starch,  as  in  boiled 
potatoes,  in  some  pastry,  etc. 

Uncooked  vegetables,  as  a  rule. 

Sugar  in  large  quantities. 

Sweet  wines. 

Tea,  under  some  conditions. 

III.  The  questions  of  alcohol,  vegetarianism,  low  diet,  milk  diet, 

and  grape  diet  discussed. 


Unfit  for  all  whose  diges- 
tive powers,  by  reason 
of  latent  gout,  chronic 
biliousness,  general 
debility,  or  other 
cause,  are  defective. 


ZbC   ffOO^   ^>^5tcm— {continued) 


CHAPTER    IX. 
DISEASES  DUE   TO   FOOD. 

(C)  TO  UNSUITABLE  FOOD. 

Of  diseases  due  to  improper  foods  there  are  two  great 
classes,  the  first  comprising  articles  of  diet  which  contain 
animal  or  vegetable  substances  more  or  less  deleterious  to 
mankind  in  general;  the  second  including  certain  com- 
pound or  even  certain  simple  foods,  which,  in  some  indi- 
viduals and  under  some  conditions  only,  may  set  up  signs 
of  disorder.  The  first  class  is  therefore  that  of  foods  ab- 
solutely  improper,  the  second  that  of  foods  relatively  im- 
proper. 

I.  Foods  absolutely  Unfit  for  Man. 

Solid  foods,  absolutely  improper. — Food,  using  the  word 
in  its  broadest  sense  to  include  all  combinations  of  nutri- 
tive material  commonly  employed  and  popularly  recog- 
nized as  food,  may  be  harmful  to  man  by  reason  of  its 
containing  certain  chemical  products,  the  result  of  decom- 
position, certain  foreign  matters  of  the  nature  of  adultera- 
tions, or  certain  animal  or  vegetable  parasites  capable  of 
entering  into  and  disturbing  the  body  of  man. 

Flesh  food  may  become  dangerous  by  reason  of  its  con- 
10 


218  DISEASES   DUE   TO    UNSUITABLE   FOOD. 

taining  certain  parasites.  The  flesh  of  the  pig,  of  the 
bullock,  of  the  cow,  and  of  the  calf  may  be  infested  with 
various  members  of  the  tape-worm  family,  in  that  stage 
of  development  in  which  they  are  called  cysticerci;  which 
immature  forms,  when  consumed  by  man,  can  complete 
their  life-history  within  his  body,  there  arriving  at  the 
mature  tape-worm.  Smoking  and  salting  lessen  the  dan- 
ger from  the  consumption  of  flesh  thus  tainted,  while 
thorough  cooking  renders  it  absolutely  safe. 

A  second  parasite,  the  Trichina  spiralis,  is  found  only  in 
the  meat  of  the  pig,  nor  does  smoking,  freezing,  salting, 
nor  even  decomposition,  serve  as  efiicient  protection  to  the 
consumer  thereof,  while  even  thorough  cooking  may  fail 
to  destroy  the  parasite.  The  disease  resulting  in  man 
from  such  meat  goes  by  the  name  of  Trichinosis,  and 
bears  a  strong  likeness  in  its  general  symptoms  to  typhoid 
fever,  for  which  it  has  been  often  mistaken. 

With  regard  to  the  non-parasitic  diseases  that  affect 
animals  used  as  human  food.  Professor  Gamgee,  in  his 
fifth  report  to  the  Privy  Council,  gives  it  as  his  opinion 
that  one  fifth  of  the  total  quantity  of  flesh  meat  consumed 
is  derived  from  animals  suffering  from  some  malignant 
disorder,  and  thus  proves  that  the  risks  supposed  to  be 
attendant  on  the  consumption  of  such  food  have  been 
overestimated.  Direct  evidence  points  in  the  same  di- 
rection, for  Parent-Duchatelet  quotes  ("Hygiene  Pub- 
lique,"  vol.  ii.,  p.  194)  two  instances  in  which  300  horses, 
suffering  from  that  malignant  disorder  called  glanders, 
were  eaten  without  injury  to  the  consumers;  and  the  ex- 
perience of  observers  in  1870,  during  the  siege  of  Paris, 
is  a  further  powerful  proof  of  the  immunity  with  which 
flesh,  thus  dressed,  may,  as  a  rule,  be  partaken  of. 

On  the  other   hand,  quite  recently.  Dr.  Woodhead  of 
Edinburgh,  in  an  elaborate  paper,  supported,  by  theory 


DANGERS    FKOM    CERTAIN    ARTICLES    OF    FOOD.         219 

and  demonstration,  the  view  that  tubercular  disease  ex- 
isting in  cattle  may  be  communicated  to  the  consumer, 
but  his  evidence,  carefully  weighed  with  the  fact  that 
tubercular  disease  is  exceedingly  frequent  in  cattle,  tends 
but  to  the  general  conclusion  drawn  from  all  the  combined 
sources  of  observation,  that,  while  it  is  injudicious  to  eat 
the  flesh  of  animals  dying  of  any  severe  disorder  which 
alters  radically  the  constitution  of  their  blood  and  of  their 
tissues,  it  cannot  with  truth  be  said  that  such  a  course  is 
attended  by  very  grave  risk. 

The  opponents  of  meat-eating,  who  always  insist  on  the 
dangers  attendant  on  the  consumption  of  animal  food, 
have  a  stronger  case  where  the  eating  of  decomposing 
meat  comes  in  question.  Numerous  and  excellent  foreign 
observers,  such  as  Schmiedeberg,  Brieger,  Zuelzer,  Koppe, 
and  y.  Anrep,  have  obtained  from  flesh,  in  a  state  of  pu- 
trefaction, substances  that  are  allied  in  action  to  the  most 
deadly  of  the  known  vegetable  alkaloids,  while  hundreds 
of  medical  men,  in  all  countries,  can  cite  cases  of  acute 
disorder  in  which  the  connection  between  illness  and  the 
ingestion  of  food — generally  of  swine  flesh  or  of  fish — 
that  had  undergone  putrefactive  change,  is  clear.  Even 
here,  however,  it  seems  necessary  to  the  production  of 
poisonous  symptoms  that  decomposition  should  have  far 
advanced,  a  state  of  matters  that  can  only,  when  the  meat 
is  mixed  with  other  ingredients  and  highly  seasoned,  as  in 
sausages,  escape  the  observation  of  the  consumer. 

But  it  would  be  wrong  to  conclude  that  even  putrid 
meat  is  always,  or  even  frequently,  poisonous.  Accord- 
ing to  Wilkes,'^  as  quoted  by  Dr.  Pavy  :  "  The  American 
Indians  all  prefer  their  meat  putrid.  Parts  of  the  salmon 
they  bury  underground  for  two  or  three  months  to  putrefy, 

*  "U.  S.  Exploring  Expedition,"  vol.  iv,,  p.  45^. 


220  DISEASES   DUE    TO    UNSUITABLE    FOOD. 

and  the  more  it  is  decayed  the  greater  delicacy  they  con- 
sider it."  Simmonds,  in  his  "  Curiosities  of  Food,"  also 
says  :  "  The  flesh  (of  the  seal)  half  frozen,  half  putrid,  in 
which  state  the  Greenlanders  term  it  mikiak,  is  eaten  with 
the  keenest  appetite." 

In  these  cases,  and  in  similar  ones  that  might  be  quoted, 
there  exists,  no  doubt,  the  strongly  protective  influence  of 
habit  gradually  acquired,  but  even  after  every  allowance 
has  been  made  for  this,  there  will  yet  remain,  in  the  minds 
of  the  impartial,  grave  doubts  as  to  the  accuracy  of  the 
views  of  modern  hobbyists  who  threaten  with  the  most 
awful  consequences  the  careless  consumer  of  meats  more 
than  doubtfully  fresh. 

Apart  altogether  from  their  relative  indigestibility,  and 
the  direct  consequences  thereof — namely,  colic,  vomiting, 
and  nettle-rash — shell-fish,  especially  mussels,  are  apt  occa- 
sionally to  produce  symptoms  of  severe  blood  contamina- 
tion in  the  consumers  ;  coma,  paralysis,  convulsions,  and 
even  death  having  not  unfrequently  followed  their  use. 
It  has  been  recently  proved  that  these  symptoms,  which 
are  identical  with  those  that  characterize  the  occasional 
poisoning  by  putrid  meat,  are  due  to  an  identical  class  of 
poison,  called  in  both  cases  a  ptomaine,  which  would  seem 
to  exist  as  a  normal  constituent  in  the  bodies  of  certain 
varieties  of  the  mussel  family. 

Finally,  flesh  food  may  become  poisonous  from  the  ad- 
ministration during  life  to  the  cattle  of  various  medicines, 
especially  of  arsenic  and  of  antimony  ;  or  from  the  fact 
that  the  cattle  have  grazed  on  land  on  which  noxious 
herbs  flourish.  Evil  consequences  to  man  from  either  of 
the  latter  causes  are,  in  this  country,  exceedingly  rare. 

From  decomposing  eggs,  milk,  and  cheese,  it  is  also 
claimed  that  various  substances  exerting  a  poisonous  in- 
fluence on  man  have  been  obtained. 


DANGERS    FROM    CERTAIN    ARTICLES    OF    FOOD.         221 

Mits  aSord  no  breeding-place  for  parasites,  nor  does  their 
decomposition  result  in  any  known  active  blood  poison. 
The  rancidity  of  fat,  the  result  of  bad  preservation  and 
other  conditions,  and  which  often  occurs  spontaneously  in 
the  stomach  of  the  dyspeptic,  is  due  to  a  partial  conversion 
of  the  fat  into  fatty  acids  (butyric,  valerianic,  etc.).  These 
are  capable  of  irritating  severely  the  coatings  of  the  stom- 
ach and  intestine,  and  of  thus  producing  pain,  vomiting,  and 
diarrhoea,  but  not  of  producing  any  disorder  of  the  blood. 

/Starches  and  sugars,  and  the  food  compounds  into  which 
they  usually  enter,  become  rarely  a  source  of  danger. 
Flour,  and  therefore  also  bread,  are  the  two  materials  in 
which  adulteration  is  most  practised.  Alum,  the  addition 
of  which  is  now  forbidden  by  law,  was  formerly  a  very 
common,  and  is,  even  now,  an  occasional  ingredient  in  the 
staff  of  life.  Its  effects  consist  of  the  ordinary  symptoms 
of  dyspepsia,  but  cannot  be  spoken  of  as  absolutely  poison- 
ous. Lead  has  been  found  in  bread,  and,  as  its  origin  in 
the  following  case  of  poisoning  is  instructive,  and  the 
symptoms  which  it  sets  up  are  always  grave  and  usually 
insidious  in  their  advance,  it  may  be  well  to  refer  to  it.  It 
occurred  at  Taunton,  and  was  reported  in  the  Sanitary 
Record,  May  25,  1877,  by  Dr.  Alford  of  that  city.  From 
fifteen  to  twenty  persons  suffered.  After  prolonged  in- 
quiry the  origin  of  the  lead  was  traced  to  the  bread,  and 
thence  to  a  certain  flour-mill,  where  it  was  found  that 
crevices  in  the  millstones  had  been  filled  with  lead,  while 
on  further  investigation  it  came  out  that  there  existed  a 
widespread  custom  of  mending  such  spaces  by  filling  them 
with  red-lead  and  borax,  or  with  alum  and  borax. 

Flint,  the  carbonates  of  lime  and  of  magnesium,  clay, 
and  gypsum  are  among  the  less  important  and  least  fre- 
quent adulterations  of  flour,  and  do  not  give  rise,  unless 
present  in  large  quantities,  to  much  derangement. 


222  DISEASES    DUE   TO    UNSUITABLE    FOOD. 

Rye,  but  also  occasionally  wheat  and  barley,  may  be 
attacked  by  a  fungus  called  Ergot,  which  grows  in  such  a 
way  on  the  grains  as  to  represent  a  spur.  Flour  made 
from  grain  thus  diseased  has  rarely  been  found  in  this 
country,  and,  spite  of  the  confident  statements  of  some 
observers,  it  is  open  to  question  whether  the  consumption 
of  ergotized  flour  is  really  fraught  with  as  much  risk  as 
has  been  represented  by  English  writers  who  have  had  but 
little  opportunity  of  practically  studying  the  question. 
This  only  is  certain,  that  at  times,  when  the  blight  has 
been  xinxisually  severe,  the  inhabitants  of  wide  districts  in 
the  south  of  Europe  have  suffered  from  gangrenous  and 
convulsive  disorders,  while  at  other  times  they  have  con- 
sumed, for  prolonged  periods,  and  in  small  amounts,  this 
fungus  without  becoming  the  victims  of  either  form  of  dis- 
ease. It  is  probable  that  habit  may  here,  as  everywhere 
else,  produce  a  tolerance  w^hich  may  account  for  the  diver- 
gent views  of  different  authorities.* 

But  we  must  pause  here  to  devote  a  few  lines  to  treat- 
ment. 

Tape-worm. — The  preventive  treatment  of  tape -worm 
consists  in  the  consumption  only  of  beef,  veal,  and  pig's 
flesh  that  have  undergone  a  thorough  process  of  cooking. 

The  indications  of  the  presence  of  this  parasite  are 
somewhat  obscure,  and  vary  widely  in  different  persons. 
Vague  signs  of  indigestion,  accompanied  by  frequent  pain 
of  a  twisting  character  in  the  region  of  the  navel,  are  com- 
mon, but  not  characteristic  symptoms.  In  some  few  cases 
the  irritation  set  up  by  this  uninvited  guest  may,  by  reflex 
influence,  produce  disorder  of  an  alarming  nature.    I  have 

*  Professor  Hamilton,  of  Edinburgh  ("Practical  Observations  on 
Midwifery,"  vol.  ii.,  p.  87,  1836),  speaks  of  ergoted  r^'e  bread  having 
been  eaten  from  time  immemorial  by  peasants  in  certain  parts  of 
France,  with  perfect  Impunity. 


TREATMENT    OF   TAPE- WORM.  223 

on  several  occasions  seen  Epilepsy  and  even  Chorea  (St.  Vi- 
tus's  Dance)  thus  take  their  origin.  Nervous  Depression, 
obstinate  Vertigo,  Cough,  Aching  in  the  Limhs,  Palpitation 
of  the  Heart,  and  Disturhances  of  the  Special  Senses  are 
other,  and  even  more  rare,  so-called  "reflex  "  (^.  e.,  reflected) 
nerve  disorders  set  up  by  this  parasite. 

The  treatment  of  tape-worm  is  simple  but  not  always 
satisfactory.  Oil  of  male  fern  and  turpentine  are  the  two 
most  effectual  remedies.  Suitable  formulae  for  their  em- 
ployment will  be  found  in  the  Appendix. 

The  Trichina  spiralis^  which  produces  in  man  the  dis- 
ease known  as  Trichinosis,  occurs  only  in  the  flesh  of  the 
pig.  Thorough  cooking  is  the  best  preventive  of  the 
disorder. 

The  symptoms  of  Trichinosis  are  closely  similar  to  those 
of  Typhoid  Fever,  but  the  former  disease  is  generally  at- 
tended by  most  severe  muscular  pain  and  often  by  puffi- 
ness  of  parts  of  the  body,  and  especially  of  the  face — 
symptoms  that  are  always  rare,  and  never  prominent,  in 
typhoid  fever.  The  duration  of  the  acute  stage  of  trichi- 
nosis often  extends  to  two  months,  that  of  typhoid  to 
rarely  longer  than  four  weeks  ;  the  convalescence  from 
the  former  complaint  is  slow,  intermittent,  unsatisfactory, 
and  often  very  incomplete ;  that  from  typhoid,  except  in 
rare  instances,  while  also  slow,  is  steady  and  complete. 

The  treatment  consists  simply  in  procuring  rest  and  quiet 
in  a  warm  room  for  the  invalid,  and  the  administration  of 
foods  suited  to  the  digestive  capacity.  In  the  early  stages 
Nature  herself  seeks,  by  vomiting  and  diarrhoea,  to  throw 
out  the  parasite,  and  these  symptoms  may  be  judiciously 
encouraged  by  the  administration  of  small  doses  of  some 
simple  purgative.  No  known  medicine  has  any  power  to 
dispossess  the  trichinae  that  have  once  obtained  lodgment 
in  the  muscular  tissues. 


224  DISEASES    DUE   TO    UNSUITABLE   FOOD. 

Poisoning  from  Ptomaines. — When,  as  an  apparently 
direct  result  of  the  consumption  of  questionable  meat  or 
fish,  or  of  even  fresh  mussels,  vomiting,  colicky  pains,  diar- 
rhoea, signs  of  paralysis,  defective  vision,  giddiness,  failure 
of  the  heart,  coldness  and  clamminess  of  the  skin,  and  a 
tendency  to  profound  somnolency  appear,  prompt  meas- 
ures to  evacuate  the  stomach  by  the  aid  of  an  emetic,  and 
the  bowel  by  the  aid  of  a  purgative,  must  be  taken.  The 
patient  should  be  encouraged  to  lie  down,  his  agitation 
should  be  soothed,  hot  bran  bags  or  poultices  applied  over 
the  stomach,  and  a  rapid  stimulant  be  administered  (hot, 
fresh  coffee,  without  milk,  or  hot  brandy  and  water,  are 
usually  the  best  and  most  handy).  These  measured  will 
suffice  till  the  arrival  of  the  doctor.  It  is  worthy  of  re- 
mark, and  I  mention  it  only  as  a  curiosity,  that  atropine, 
an  alkaloid  prepared  from  belladonna,  and  whose  effects 
are  a  close  counterpart  of  those  seen  in  ptomaine  poison- 
ing, seems  to  be  the  drug  most  potent  in  its  power  of 
relieving  the  symptoms,  for  which  purpose  it  is  recom- 
mended by  Dr.  Lauder  Brunton.* 

Improper  Liquid  Foods. 

Fluids  commonly  in  use  as  beverages  may  become,  by 
chance  or  design,  so  contaminated  by  dangerous  material 
as  to  come  under  the  heading  of  food  absolutely  and  in 
all  cases  improper. 

Water. — No  substance  appears  to  possess  such  a  charm 
for  the  hygienist,  professional  or  amateur,  as  water,  and 
certainly  none  has  been  the  subject  of  so  much  cant  and 
humbug.  Let  us  therefore  try  and  clear  the  ground  a  little 
ere  we  come  to  consider  its  real  and  dangerous,  albeit  rare, 
contaminations.  An  adult  man  excretes,  by  the  lungs, 
skin,  and  kidneys,  about  5  lbs.  of  water  per  diem,  which 

*  "Disorders  of  Digestion," p.  284. 


WATER    CONTAMINATED    BY    LEAD.  225 

amount  has,  perforce,  for  the  maintenance  of  the  balance 
of  health,  to  be  each  day  replaced.  It  is,  however,  by  no 
means  necessary  to  drink  daily  to  that  extent  of  water,  for, 
in  the  first  place,  even  our  so-called  "  solid  "  foods,  such 
as  meat,  fish,  bread,  potatoes,  etc.,  consist  of  more  than 
half  their  weight  of  water,  while  in  nearly  all  fruits  and 
vegetables  the  percentage  of  this  fluid  present  varies  from 
80  to  97  per  cent.;  while  in  the  second  place,  the  changes 
undergone  by  fuel-foods  in  the  body — and  even  to  a  slight 
extent  by  the  tissue -foods  —  result,  as  we  know,  in  the 
production  of  water  and  carbonic  acid.  By  the  operation 
of  these  and  many  other  modifying  causes,  the  physiologi- 
cal requirements  of  the  body  are,  of  course,  very  consider- 
ably, and  in  different  people  very  variously,  affected. 

But  passing  from  the  question  of  quantity,  for  which  the 
only  recognized,  and  the  rarely  failing  guide  is  the  bodily 
demand,  as  indicated  by  the  thirst,  to  that  of  quality,  we 
have  to  ask  ourselves  the  practical  question  —  What  ma- 
terials may,  under  the  ordinary  conditions  of  life,  find  an 
entrance  into  the  water  supply  and  render  that  fluid  abso- 
lutely and  unquestionably  deleterious  ?  And  the  answer 
is,  that  lead,  certain  earthy  salts,  and  the  germs  of  some 
diseases  constitute  practically  the  only  real  poisons. 

Water  contaminated  by  Oxide  of  Lead. — The  oxygen  in 
water  may  act  under  certain  conditions  on  metallic  lead, 
forming  a  highly  poisonous  salt,  all  the  more  dangerous 
inasmuch  as  its  presence  is  not  indicated  by  any  discolora- 
tion of,  or  any  smell  imparted  to,  the  fluid.  If,  however, 
the  water  contain  an  abundance  of  earthy  sulphates,  an 
insoluble,  and  therefore  protective,  film  of  sulphate  of  lead 
is  almost  immediately  formed  on  the  surface  of  the  metal, 
effectually  shielding  the  fluid  from  dangerous  contact. 
Phosphates  act  in  the  same  manner,  but  the  carbonates 
are  not  to  be  relied  on,  for  the  incrustation  of  carbonate 
JO* 


2€6  DISEASES    DUE    TO    UNSUITABLE    FOOD. 

of  lead  formed  by  them  is  apt  to  be  redissolved  by  any  ex- 
cess of  carbonic  acid  accidentally  present  in  the  water. 

The  dangers  of  lead  poisoning  from  the  consumption  of 
any  of  the  drinking-waters  supplied  in  our  larger  towns 
is,  thanks  to  the  measures  taken  to  insure  a  safe  and  good 
quality,  exceedingly  remote.  The  only  precautions  I  need 
urge  on  town-dwellers  have  reference  to  distilled  and  puri- 
fied, aerated,  waters,  wliich,  lacking  the  above-mentioned 
protective  salts,  may,  by  contact  with  the  fittings  or  taps 
of  the  receptacles  in  which  they  are  stored,  dissolve  out 
considerable  quantities  of  the  dangerous  metal.  The  same 
remarks  apply  to  rain-water,  or  to  water  from  any  source 
which  has  not  been  certified  as  safe  by  a  competent  au- 
thority. These,  if  used  as  beverages,  should  not  pass 
along  leaden  pipes  nor  be  kept  in  leaden  cisterns. 

The  detection  of  lead  in  water  is  within  the  capacity  of 
any  chemist,  but  a  reliable  verdict  on  the  safety  of  any 
given  specimen  of  water  is  obtainable  only  from  those 
who  possess  certain  necessary  appliances  and  some  con- 
siderable skill  and  experience  on  this  special  subject. 

The  signs  of  lead  poisoning  are  sufficiently  characteris- 
tic to  offer  no  difiiculty  in  diagnosis.  Though  exceed- 
ingly insidious  at  first,  the  symptoms,  which  occur  gen- 
erally in  the  following  order,  are  so  steadily  progressive 
and  so  inconvenient  as,  with  rare  exceptions,  to  insure 
attention  before  any  very  grave  mischief  is  done  :  Consti- 
pation, scanty  and  dark  stools,  and  highly  colored  urine  ; 
Severe  Colic,  marked  by  twisting  and  grinding  pains  of 
great  severity  in  the  region  of  the  navel ;  the  formation 
of  a  Blue  Line  where  the  gums  and  teeth  meet ;  weakness 
and  trembling,  followed  by  actual  Palsy  of  the  muscles  of 
the  arm,  commencing  usually  in  the  hand  and  wrist,  and 
causing  the  well-known  and  characteristic  ** Wrist-drop;" 
and  a  sallow  appearance  of  the  skin — such  is  the  common 


WATER    CONTAMINATED    BY    LEAD.  227 

sequence  of  phenomena  due  to  the  absorption  of  lead  into 
the  system.  Sometimes,  however,  constipation,  muscular 
debility,  and  Jlyi?i(/  pains  of  a  rheumatic  or  gouty  appear- 
ance, severe  headache,  and  irregular  action  of  the  heart 
are  the  only  predominant  symptoms.  Finally,  where  the 
amount  of  lead  present  has  been  large,  all  the  signs  of  poi- 
soning, which  usually  occupy  weeks  or  months,  may  be 
developed  in  a  few  days,  or  even  hours.  Vomiting,  a  quick, 
weak  pulse,  cramp  in  the  muscles,  especially  in  those  of  the 
legs,  stupor,  giddijiess,  and  coma  are  then  the  most  striking 
proofs  of  the  existence  of  this  poison. 

Can,  then,  the  presence  of  lead  in  water  be  said  with 
absolute  correctness  to  be  always  and  in  all  proportions 
deleterious  ?  ]^o  ;  the  wonderful  powers  of  accommoda- 
tion possessed  by  the  body  of  man,  the  outcome  of  many 
thousands  of  years  of  exposure  to  countless  variations  in 
his  surroundings,  enable  it,  within  certain  limits,  to  toler- 
ate, without  disorder,  in  its  daily  food  supply,  a  small  pro- 
portion of  this  metal,  absolutely  foreign  as  it  is  to  its  con- 
stitution. Thus  we  find  that  although  practically  in  every 
water  that  has  been  conveyed  along  leaden  pipes  there  is 
always  found  a  trace  of  lead,  yet  that  unless  the  amount 
rise  above  -^-^  of  a  grain  of  this  metal  to  the  gallon,  no 
noticeable  consequences  ensue  from  its  consumption. 

The  treatment  of  poisoning  by  lead,  whatever  be  its 
source,  consists  in  the  observation  of  the  following  simple 
rules  :  {a)  Stop  the  source  of  the  lead  supply  ;  *  (b)  con- 
vert any  oxide  of  lead  that  may  be  lying  in  the  stomach 
or  intestines  to  an  insoluble  sulphate  by  taking  a  prepara- 
tion of  sulphate  of  magnesium  (Epsom  salts)  or  sulphate 
of  sodium  (Glauber's  salt)  ;  (c)  give  thrice  daily,  and  in 

*  This  of  course  is  to  be  obtained  by  cutting  oif  the  contaminated 
water-supply,  but  it  is  worthy  of  note  that  the  filtration  of  water 
through  spongy  iron  will  remove  lead. 


228  DISEASES    DUE    TO    UNSUITABLE    FOOD. 

combination  with  iron  if  great  sallowness  be  present,  a  five- 
grain  dose  of  iodide  of  sodium  {vide  recipe  in  Appendix, 
Formula  No.  5),  which  will  form  with  the  lead  in  the  tis- 
sues an  insoluble  iodide  of  lead.  In  bad  cases  this  medica- 
tion may  be  kept  up  for  as  long  as  six  months. 

Water  unfit  for  Use  hy  reason  of  the  great  preponderance 
therein  of  certain  Salts. 

It  is  by  no  means  as  yet  certain  that  an  excess  of  any 
inorganic  salt  in  water  can  give  rise  to  disorder.  Two 
diseases  have,  however,  from  time  immemorial,  been  asso- 
ciated in  the  medical  mind  with  a  consumption  of  waters 
rich  in  lime  salts  —  to  wit,  Phosphatic  Stone  and  Goitre. 
With  regard  to  the  former,  Professor  Gamgee  has  stated 
that  sheep  are  particularly  affected  by  phosphate  of  lime 
calculi  in  the  limestone  districts,  while  the  excess  of  cases 
of  phosphatic  stone  in  the  county  of  Norfolk  has  been,  till 
quite  recently,  always  ascribed  to  the  drinking  of  water 
rich  in  the  carbonate  of  lime.  Dr.  Wang,  however,  in  his 
Chinese  Customs  Report  of  1870,  pointed  out  that  at  Can- 
ton, while  phosphatic  stone  was  an  exceedingly  common 
complaint,  it  was  clearly  not  in  any  way  associated  with 
the  presence  of  carbonate  of  lime  in  the  drinking-water, 
since  the  Chinese  there  always  drank  boiled  water.  Dr. 
Richardson  has  also  from  time  to  time  brought  forth  evi- 
dence adverse  to  the  popular  view  of  the  causation  of  stone 
in  the  Norfolk  district.* 

The  real  solution  of  the  mystery  is  probably  as  follows: 

*  The  reader  must  not  confound  the  phosphatic  stones  here  men- 
tioned (the  soft,  white,  smooth  phosphate  of  lime  calculi,  and  the 
rough,  hard,  irritating  oxalate  of  lime  calculi)  with  the  uric  acid 
stones  and  gravel  of  gout.  All  varieties  of  stone,  however,  produce 
the  same  symptoms,  and  probably,  vide  supra,  are  more  closely  allied 
in  their  causation  than  is  commonly  thought. 


TREATMENT    OF    PHOSPIIATIC    STONE.  229 

Derangements  of  the  digestive  apparatus  lead  to  the  for- 
mation of  every  variety  of  stone,  and  such  derangements 
are  u&n^Wy  favored  by  certain  hard  waters  containing  car- 
bonate of  lime  (^.  e.,  chalk  or  limestone)  in  large  amount. 

There  is,  moreover,  a  distinct  connection  between  ner- 
vous exhaustion  and  the  formation  of  phosphatic  calculi 
that  is  quite  independent  of  any  peculiarity  in  the  water- 
supply. 

As  to  the  treatment  of  phosphatic  stone,  it  cannot  be 
justly  claimed  for  medicine  that  it  has  achieved  any  tri- 
umphs, spite  of  the  pretensions  of  innumerable  quacks,  in 
the  cure  of  this  disorder,  when  once  it  has  become  estab- 
lished. The  formation  of  a  stone  may  be  prevented,  or  its 
increase  when  once  formed  be  kept  down,  by  attention  to 
the  digestive  organs,  and  by  the  consumption  of  large  quan- 
tities of  boiled  or  distilled  water  ;  while  the  pain  it  pro- 
duces, if  its  shape  be  irregular,  as  it  will  be  if  its  consist- 
ence be  mainly  or  wholly  oxalate  of  lime,  may  be  lessenecl, 
at  the  cost  of  an  increase  in  size  and  weight,  by  the  steady 
administration  of  lime-water,  which  promotes  directly  a 
deposition  of  the  phosphate  of  lime  on  the  calculus,  thus 
rounding  off  the  irregularities  of  surface  while  increasing 
its  total  bulk. 

The  dependence  of  Endemic  Goitre,  or  of  Cretinism,  a 
form  of  endemic  idiocy  combined  with  goitre,  on  peculiari- 
ties in  the  water  supply,  is  no  better  established  than  is 
the  case  of  the  phosphate  of  lime  stones  just  discussed,  nor 
indeed  are  the  various  authorities  who  have  written  ex- 
tensively on  the  subject  in  accord  among  themselves  as  to 
the  special  salt  that  is  harmful,  the  one  affirming  it  to  be 
carbonate  of  lime,  a  second,  with  equal  confidence,  sulphide 
of  iron,  while  a  third  denounces  the  magnesium  salts. 

The  only  conclusion  that  can  be  drawn  from  a  study  of 
all  the  authorities  is  that,  as  in  the  "case  of  stone,  a  water 


230  DISEASES   DUE   TO    UNSUITABLE   FOOD. 

somewbat  unsuitable  to  tbe  bodily  wants  will  predispose 
to  the  formation  of  goitre  and  cretinism,  but  is  powerless 
alone  to  produce  either  of  them. 

Water  wifit  for  Use  hy  reason  of  contamination  loith  cer- 
tain forms  of  Organic  Matter ^  living  or  dead. 

Animal  organic  matter,  in  particular  recent  faecal  matter, 
and  in  some  cases  even  vegetable  organic  matter,  especial- 
ly that  from  marshes,  may  constitute  noxious  ingredients 
when  present  in  drinking-water. 

That  many  diseases  travel  from  one  individual,  or  from 
one  town,  to  another,  by  the  agency  of  fluids,  and  especial- 
ly of  water,  has  long  been  absolutely  certain,  but  why  at 
one  time,  or  under  one  set  of  conditions,  organic  mate- 
rial should,  when  present  in  such  fluids,  set  up  disorder  and 
not  at  another,  and  why  at  one  time  of  the  year  such  dis- 
order should  take  the  form  of  cholera  or  typhoid,  and  at 
another  that  only  of  some  very  trivial  loss  of  health,  were 
questions  which  for  long  defied  explanation.  It  is  only  with- 
in the  last  twenty  years  that  the  following  facts,  of  which 
I  present  a  short  summary,  have  been  established,  and  that 
light  has  thus  been  thrown  on  the  causation  of  a  vast  num- 
ber of  epidemic  and  endemic  derangements. 

All  air,  as  well  that  in  the  atmosphere  as  that  in  water, 
contains  numberless  fungi,  parasitic  plants  of  extreme 
smallness,  which  settle  on  and  propagate  themselves  in 
dead  or  feeble  organic  matter,  therein  setting  up  the  fer- 
mentative changes  which  we  know  as  putrefaction. 

These  parasites,  popularly  called  ''germs,"  scientifically 
bacteria  or  bacilli,  play  thus  a  very  useful  role  in  Nature 
by  restoring  devitalized  organic  matter  once  more  to  the 
inorganic  world. 

When  the  body  of  man  is  in  a  condition  of  health,  and 
the  germs  are  of  the  kind  and  order  to  which  it  is  accus- 


DEVELOPMENT    OF    DISEASE    GERMS.  231 

tomed — for  millious  of  them  are  swallowed  at  every  meal 
and  inhaled  in  every  act  of  inspiration — these  parasitic  fungi 
are,  like  every  other  ordinary  and  common  force  in  his  en- 
vironment, of  use  in  the  maintenance  of  his  health  and  life. 

But  when — 

(a)  The  human  body  is  iceaJc,  any  of  the  ordinary  forces 
in  its  environment — such  as  a  mere  current  of  air,  a  fall 
of  temperature,  a  commonplace  article  of  food — will,  by 
their  being  in  excess  of  the  counteracting,  the  balancing, 
power  of  the  body,  become  a  source  of  danger  and  set  up 
disorder.  Under  such  conditions  these  parasites,  also 
useful  and  necessary  as  they  are  to  the  life  and  contin- 
uance of  health  of  man,  may  become  agents  of  disease. 

{b)  Or^  tJie  germ,  by  reason  of  the  effect  on  it  of  un- 
usual circumstances,  such  as  heat  and  moisture  or  other 
conditions  specially  favorable  to  its  development,  may  be- 
come, by  virtue  of  such  development,  a  new  and  therefore 
an  unbalanceable*  force  in  the  environment  of  man,  and 
then  also  the  equilibrium  of  the  body  of  man  will  tempo- 
rarily or  permanently,  according  to  the  nature  of  such  germ, 
be  overthrown. 

Of  course,  if  both  conditions  be  present — ^.  e.,  if  the 
human  body  be  both  weak  and  the  germ  be  of  unusual 
kind — then  will  not  only  the  health  be  sooner  and  more 
easily,  but  almost  more  completely,  upset. 

By  the  light  of  the  above  brief  summary,  all  the  riddles 
of  epidemic  and  endemic  disease  and  many  other  blood 
derangements  may  be  read. 

But  we  have  yet  to  ask — What  are  the  conditions  un- 

*  Only  at  first  unbalanceable,  for  if  frequently  present,  the  bodies 
exposed  to  it  become  acclimatized  thereto.  Thus  the  germs  of  ague 
attack  the  new-comer  to  a  marshy  district,  while  the  descendants 
of  those  who  have  for  generations  inliabited  the  region  enjoy  an  al- 
most complete  exemption,  and  so  with  all  other  fevers. 


232  DISEASES    DUE    TO    UNSUITABLE    FOOD. 

der  which,  as  far  as  is  known,  an  ordinary  innocuous  bac- 
terium may  develop  into  a  form  which,  by  reason  of  its 
novelty,  and  not  of  any  special  intrinsic  force^  may  consti- 
tute a  danger? 

1.  The  absence,  or  comparative  absence,  of  oxygen  is 
one.  If  you  suddenly  change  the  environment  of  a  para- 
sitic fungus,  you  change  also,  and  in  necessary  proportion 
thereto,  its  very  constitution  and  its  functions,  although 
its  identity  remains.  It  is  remarkable  under  what  extraor- 
dinarily opi^osite  conditions  most  of  the  lower  forms  of 
life  can  exist.  Take  the  parasitic  yeast  jjlant  and  ring- 
worm plant  as  examples.  They  can  both  live  without 
oxygen  or  with  oxygen,  but  their  functions,  even  their 
very  modes  of  reproduction,  change  according  to  the  pres- 
ence or  absence  of  that  gas. 

2.  The  presence  of  an  abundance  of  organic  matter  is 
another  condition  which,  as  we  can  readily  understand,  is 
highly  favorable  to  bacterial  development. 

N.  B. — Taking  the  two  last  conditions  together,  let  us 
consider  how  often  disease  springs  from  the  combination. 
The  germs  of  typhus  (the  old  jail  fever)  are  developed 
when  human  beings  are  crowded  together  in  an  atmos- 
phere the  oxygen  of  which  is  exhausted.  The  living 
germ  of  fever  is  not  produced  by  such  a  combination  of 
circumstances  ;  it  is  simply  devseloped.  For  this  reason  the 
atmosphere  of  a  hospital  is  favorable  to  erysipelas  and 
wound-fever  (pyaemia),  and  the  statistics  of  second-rate 
men,  operating  under  apparently  great  disadvantage  in 
country  districts,  are  often  better  than  those  of  the  best 
operating  hospital  surgeons  of  our  large  towns. 

3.  Heat  has  a  well-known  and  powerful  effect  on  de- 
velopment in  the  lowlier  forms  of  life.  It  is  in  the  hot 
season  in  India  that,  other  conditions  being  favorable,  the 
cholera-germ  puts  in  an  appearance  ;  it  is  during  the  hot 


THE  GENESIS  OF  FEVER  GERMS.  233 

months  of  July  and  August  that  English  cholera-germs 
Spread  death  broadcast  among  the  children  of  that  land, 
especially  among  those  who  reside  in  certain  —  usually 
damp — localities  ;  it  is  after  a  hot  summer  that  typhoid 
fever  is  most  common. 

But,  while  a  high  temperature  favors  the  development 
of  these  forms  of  parasitic  life,  or  awakes  them  to  life 
after  a  long  period  of  suspended  animation,  a  low  temper- 
ature does  not  always  suffice  to  exterminate  them,  though 
it  seems  to  have  the  effect  generally  of  lessening  their  func- 
tional activity.  All  the  conditions  necessary  to  the  produc- 
tion of  the  germ  of  Asiatic  cholera  do  not  exist  in  Europe, 
and  when  the  scourge  reaches  that  continent  it  has  been 
always  reared  abroad,  but  it  can  live  and  even,  for  a  time, 
propagate  itself  under  European  conditions.  Its  activity, 
however,  always  lessens  with  the  fall  of  the  thermometer, 
the  germ  seeming  to  become  dormant  in  a  low  tempera- 
ture and  often  to  be  killed  by  extreme  cold. 

4.  Moisture  generally  exerts  an  influence,  especially 
when  in  combination  with  heat,  that  is  favorable  to  germ 
development. 

So  much  for  the  genesis  of  "germs"  that  can  derange 
the  human  body.  Once  developed,  can  they  travel  be- 
yond the  area  in  which  they  are  bred  ?  Yes,  if  favorable 
circumstances  be  present. 

As  a  matter  of  fact  we  know  that  such  germs  may 
travel  in  the  air  simply,  may  lie  hid  among  clothes — the 
cholera  is  said  more  than  once  to  have  reached  this  coun- 
try by  means  of  imported  rags — or  in  food.  Finally,  they 
may  travel  long  distances  in  fluids. 

This  last  mode  of  transit  alone  concerns  us  at  present. 

Water  is  the  commonest  medium  of  communication, 
but  milk,  or  any  other  non-alcoholic  medium,  may  appar- 
ently serve  as  a  vehicle. 


234  DISEASES    DUE    TO    UNSUITABLE    FOOD. 

Amono:  well-known  disorders  that  select  water  as  tbeir 
T[\Q([\\xm^ty2yhoid  fever  and  cholera  may  be  noted.  The 
germ  of  either  disorder  once  conveyed  to  running  water 
may  carry  the  epidemic  over  the  country  ;  indeed,  in  most 
cases  there  may  be  traced  a  direct  contamination  of  the 
water  by  the  excretions  of  sufferers.  A  vast  quantity  of 
sewage  no  doubt  does,  actually  must,  find  its  way  into  the 
water-supply  of  every  city,  especially  if  the  source  of  sup- 
ply be  a  lake  or  river.  This,  if  dissolved  in  the  water  and 
not  excessive  in  amount,  has  no  appreciable  effect  on  the 
health  of  the  consumers,  and  it  is  only  when  an  epidemic 
of  Asiatic  cholera  reaches  our  shores  and  we  find,  while 
the  disease  is  rarely  or  never  communicated  by  the  air,  it 
follows  very  markedly  the  course  of  the  large  rivers,  that 
we  begin  to  suspect  that  the  fluid  which  we  have  consumed 
for  so  long,  while  under  ordinary  conditions  perfectly 
wholesome,  was  not  so  absolutely  pure  as  we  had  fondly 
imagined.  Nearly  all  the  great  Indian  authorities  consid- 
er contaminated  water  as  almost  the  sole  means  of  cholera 
transit,  and  they  nearly  all  agree  that  the  disease  is  rarely 
or  never  conveyed  by  the  breath  of  the  patient  nor  by  the 
air  that  has  passed  over  his  body. 

The  same  remarks  apply — with  some  slight  differences, 
for  each  germ  has  its  own  conditions  of  life — to  typhoid 
fever,  which,  by  the  almost  unanimous  opinion  of  English 
medical  authorities,  is  viewed  as  communicable  by  water, 
milk,  or  other  fluids,  but  not  otherwise  contagious. 

3Iilk,  like  water,  is  a  good  carrier  of  germs,  and  especial- 
ly of  those  of  scarlet  fever  and  of  diphtheria. 

Habit  confers  a  certain  immunity,  even  in  the  cases  of 
the  most  malignant  germs.  It  is  no  uncommon  thing  for  a 
traveller  to  be  smitten  by  typhoid  as  a  consequence  of 
drinking  but  one  draught  of  a  contaminated  water  which 
the  inhabitants  of  the  district  can  consume  without  risk  of 


THE    GENESIS    OF    FEVER    GERMS.  235 

any  kind,  while  the  same  may  be  said  in  a  lesser  degree  of 
the  malignant  cholera-germ. 

But  what  about  those  terrible-looking  forms  of  life 
shown  to  us  in  a  "  single  drop  of  London  water,"  of  which 
such  wise  commercial  use  is  made  by  the  supporters  of 
the  "pure  water"  firms?  They  are  absolutely  harmless. 
No  case  has  been  made  out  against  them.  On  this  point 
Mr.  Blyth  says  :  "  Confervoid  growths,  algae,  and  desmids 
are  met  with  in  running  streams  of  great  purity,  and  if 
these  are  the  only  structures  met  with,  a  water  should  not 
be  condemned  ;"  while  the  eminent  hygienist.  Dr.  Parkes 
("Practical  Hygiene,"  Vth  edit.,  page  and  plate  671),  says: 
"  The  presence  of  infusoria  and  animals  of  low  type  indi- 
cates the  presence  of  organic  matter,  and  it  is  therefore 
important  to  note  their  presence;  but  it  has  not  at  present 
been  shown  that  they  are  in  themselves  at  all  hurtful;" 
while  on  p.  58,  while  expressing  some  scepticism  as  to  re- 
ported cases  of  illness,  depending  solely  upon  dissolved 
organic  matter,  he  implicitly  says  :  "  Secondly,  organic 
matter,  even  to  the  amount  of  14  to  21  partsper  100,000, 
may  exist  without  bad  effects,  if  it  be  perfectly  dissolved. 
In  the  latter  cases,  however,  the  water  is  always  clear  and 
sparkling  and  never  tainted  or  discolored." 

We  may  conclude,  then,  that  while  bacteria  exist  every- 
where, in  water  as  in  air,  they  are  capable  of  developing 
into  actual  germs  of  disease  only  under  exceptional  cir- 
cumstances, but  that  when  once  formed  they  will  continue, 
as  long  as  circumstances  are  in  their  favor,  to  propagate 
themselves,  and  that,  according  to  the  conditions  necessary 
to  their  existence,  some  can  exist  for  long  and  can  propa- 
gate their  kind  in  water  or  in  milk,  while  others  can  sub- 
sist, and  therefore  can  travel,  only  in  the  air.  Germs  are 
furthermore  to  be  carefully  distinguished  from  the  infi- 
nitely larger  animalculae  which  are  found  in  nearly  all 


23G  DISEASES    DUE    TO    UNSUITABLE    FOOD. 

water,  and  which,  though  their  presence  may  occasionally 
give  rise  to  the  suspicion  of  more  organic  matter  in  that 
fluid  than  is  absolutely  compatible  with  safe  potable  water, 
yet  they  are  not  in  themselves  capable  of  doing  any  harm 
to  man,  having  been  consumed  by  him  with  impunity 
since  the  commencement  of  human  life  on  the  globe. 

How  may  we,  then,  render  suspicious  water  absolutely 
safe? 

By  hoiling.  This  rids  it  of  carbonate  of  lime,  of  iron, 
and  of  hydrogen  sulphide,  and  lessens  organic  matter.  It 
does  not  destroy,  for  a  certainty,  all  bacteria,  for  Professor 
Tyndall  has  shown  that  there  are  stages  in  the  life-his- 
tory of  the  bacteria  during  which  they  can  resist  any 
moist  heat.  Repeated  boilings,  however,  by  destroying 
each  time  a  crop  of  these  in  the  stages  during  which  they 
are  liable  to  death  by  a  temperature  of  212°  F.,  is  there- 
fore the  only  sure  means  of  rendering  water,  during  epi- 
demics of  cholera,  typhoid  fever,  scarlatina,  and  diph- 
theria, absolutely  safe  as  a  beverage.  Distillation,  if 
properly  carried  out,  renders  water,  from  whatever  source 
contaminated,  absolutely  safe.  Free  exposure  of  susjn- 
cious  water  to  air-currents  and  the  agitation  in  it  of  coke, 
spongy  iron,  or  even  scrap  iron,  always  lessen  and  some- 
times suffice  to  remove  all  danger.  Filtration,  when 
efficiently  carried  out,  is  also  a  potent  purifier  of  water 
from  dangerous  germs.  The  filtering  medium  should  by 
preference  be  spongy  iron,  the  magnetic  oxide,  or  the 
carbide,  of  iron.  Nothing  organic,  such  as  cotton-wool, 
must  enter  into  the  structure  of  the  filter,  and  all  metal, 
such  as  iron,  upon  which  water  can  act,  must  be  protected. 
Filters  of  such  construction  do  not  require  cleansing  oft- 
ener  than  once  in  every  nine  or  twelve  months.  Char- 
coal, animal  or  vegetable,  is  not  a  good  filtering  medium, 
and  in  cases  where  it  is  relied  on  should  be  thoroughly 


FOODS   RELATIVELY    UNFIT    FOll    MAN.  237 

cleansed — either  brought  to  a  red  heat,  or,  failing  that, 
well  boiled  in  dilute  Condy's  fluid,  and  afterwards  thor- 
oughly washed  and  well  exposed  to  the  air  and  sun — at 
least  once  in  every  three  months,  and  even  oftener  than 
that  during  an  epidemic. 

The  "Filtre  Rapide"  of  Maignen  is  an  excellent  and 
efficient  apparatus,  especially  in  camp  and  hospital,  or  in 
large  domestic  establishments,  where  quantities  of  water 
are  constantly  in  demand.  Like  every  other  filter,  it  must 
be  frequently  cleansed,  and  the  straining  material  renewed, 
according  to  the  work  it  has  to  do  (to  be  measured  by  the 
impurity  of  the  water  passed  through  it). 

Many  other  beverages,  besides  water  and  milk,  were 
occasionally  the  subjects  of  intermixture  with  articles 
deleterious  to  health,  but  as  at  no  time  were  they  such  as 
to  constitute  very  grave  danger,  and  as  at  the  present  day 
in  England  they  have,  thanks  to  the  Adulteration  Act  of 
1875  and  its  Amendment  of  1879,  almos^t  ceased  to  exist, 
an  enumeration  of  them  here  would  answer  no  practical 
end. 

II.  Foods  relatively  Unfit  for  Man. 

Having  then  completed  our  review  of  foods  which,  as 
regards  their  effect  on  man,  may  be  regarded  as  essentially 
bad,  we  now  turn  to  the  larger  half  of  our  subject,  that 
which  deals  with  food  but  relatively  unsuitable. 

We  all  know  that  many  men,  otherwise  vigorous  and 
strong,  have,  in  order  to  avoid  discomfort,  to  exercise  cau- 
tion in  their  selection  of  food,  while  others,  often  of  much 
the  same  age,  temperament,  habits,  and  occupation,  can 
eat  with  impunity  of  almost  every  ordinary  nutriment. 

Whence  comes  this  difference  in  the  digestive  capacity 
of  individuals  placed  in  like  circumstances  ?  The  cause 
is  to  be  found  far  back,  in  the  lives  and  habits  of  the  fore- 


238  DISEASES    DUE    TO    UNSUITABLE    FOOD. 

fathers.  Rather,  however,  than  attempt  in  one  or  two 
special  cases  to  trace  cause  and  effect,  I  will  briefly  sketch 
the  origin  of  all  digestive  incapacity. 

Primitive  man  had  few  incentives  to  action,  and  of 
these  hunger  was  doubtless  the  chief.  We  may,  perhaps 
with  truth,  say  of  him,  that  food  was  his  thought  by  day, 
his  dream  by  night,  hunger  his  main  incentive  to  action, 
instinct  his  guide,  and  satiety  his  limit.  Nevertheless, 
judging  by  the  specimens  of  his  bones  and  teeth,  the 
troubles  of  indigestion  and  the  many  diseases  with  which 
we  are  to-day  afflicted  were  as  unknown  to  him  as  to  the 
other  wild  denizens  of  the  primeval  forests. 

The  causes  which  led  to  the  slow  aggregation  of  man- 
kind into  tribes  and  nations  do  not  here  concern  us ;  we 
only  know  that  after  a  lapse  of  time  the  population  of  the 
earth  became  partly  urban  and  partly  rural,  and  that  the 
former,  accumulating  wealth  by  trade  and  other  means, 
fell  into  habits  of  luxury,  and,  discarding  the  simpler 
foods,  of  which  an  excess  could  scarcely  be  consumed  by 
reason  of  the  deadening  of  the  palate  and  the  sense  of 
satiety  which  marked  the  normal  limit  of  demand,  and 
blocked,  as  it  were,  a  further  consumption,  sought,  by 
ingenious  stimulation  of  the  palate  by  a  variety  and  mul- 
tiplicity of  flavors,  and  of  the  stomach  by  hot  condi- 
ments, to  develop  and  expand  hunger  and  eating  from 
the  fulfilment  of  a  natural  demand  into  a  means  of  sensual 
gratification. 

I>ut  if,  by  reason  of  the  comparative  inaction  of  their 
lives,  there  was  at  once  a  lessened  need  for  food,  and  an 
enormously  increased  consumption  thereof,  is  it  at  least 
not  to  be  considered  strange  that  all  communities  of  men 
were  not  promptly  exterminated  by  disease?  But  no 
such  consequences  appeared;  a  general  and  gradual  dete- 
rioration of  type  was  the  sole  result,  for  there  w  ere  pres- 


ORIGIN    OF    FEEBLE    DIGESTION.  239 

ent  several  safeguards  against  a  more  rapid  decline.  In 
the  first  place,  there  was  constantly  an  infusion,  by  mar- 
riage, of  fresh  blood  from  the  rural  population;  in  the  next, 
there,  was  the  potent  influence  of  habit,  the  body  being 
able  then,  as  now,  without  loss  of  health,  to  become  habit- 
uated within  certain  limits,  and,  provided  the  process  was 
gradual  only,  to  altered  conditions,  of  which  an  excess  of 
food  was  one;  and,  lastly,  Disease  put  out,  when  the  nar- 
row limits  within  which  habit  could  save  were  exceeded, 
her  merciful  hand,  checking  Dives  as  he  approached  de- 
struction, and  throwing  him  back^  often  violently^  into  the 
path  of  health. 

Spite  of  these  several  brakes  upon  a  downward  career, 
a  continuance  of  folly  ended,  as  I  have  said,  in  deteriora- 
tion, marked  mainly  by  a  premature  failure  of  the  diges- 
tive capacities,  and,  since  digestion  goes  on  in  every  organ 
of  the  body,  by  a  generally  premature  advent  of  the  signs 
of  old  age,  most  marked  of  course  in  those  organs  upon 
which  the  greatest  strain  happened  to  be  thrown.* 

But  the  consequences  of  luxury  and  excess  were  even 
more  grave  and  far-reaching.  The  crowding  together  of 
human  beings,  the  unnatural  and  fermenting  excreta  and 
the  absence  of  adequate  means  for  their  speedy  removal, 
co-operating  with  other  effects  of  overcrowding  and  over- 
feeding, provided  a  novel  surrounding  for  those  ubiqui- 
tous denizens  of  the  air,  the  germs  (the  bacteria),  and 
consequently  effected  in  them  a  metamorphosis.  The 
common  beneficial  bacterium  of  ordinary  putrefaction  de- 
veloped in  such  places  into  a  different  creature,  and  be- 
came at  once  dangerous  because  it  constituted  a  new,  and 
therefore  an  unbalanceable,  force  in  the  environment  of 

*  The  food  system,  as  I  have  already  remarked,  is  the  great  bodily 
sj^stem  whose  requirements  almost  every  bodily  organ  may  be  said 
to  subserve. 


240  DISEASES   DUE   TO    UNSUITABLE   FOOD. 

man,  and  consequently  strange  and  fatal  diseases,  which, 
selecting  by  preference  those  individuals  whose  bodies 
were  most  debilitated  by  excess,  now  made  their  appear- 
ance. 

This  new  force — the  fever-germ — ravaged,  as  we  know 
from  history,  large  tracts  of  country,  and,  had  it  not  been 
again  for  the  protective  influence  of  habit,  by  the  opera- 
tion of  which  even  the  new  force  lost  after  a  time  its 
novelty  and  therefore  its  danger,  in  proportion  as  the 
bodies  constantly  or  frequently  exposed  to  it  became 
more  or  less  habituated  to  its  influence,  mankind  must 
have  perished  from  the  earth. 

Thus  originated  epidemic  disease,  and  this  is  the  ex- 
planation of  the  strange  phenomenon  that,  in  different 
races  and  at  different  periods  in  history,  a  blood  disease 
will  show  that  extraordinary  difference  in  its  death-roll. 

Such  is  a  brief  epitome  of  the  genesis  of  epidemic  dis- 
ease on  the  earth,  nor  is  it  in  any  sense  a  speculative  one, 
for  any  one  of  my  readers  may,  by  the  aid  of  a  good 
microscope  and  a  little  nitrogenous  fluid,  such  as  blood 
serum,  develop  and  cultivate  from  the  ordinary  germs  of 
the  surrounding  air  other  and  different  beings,  and  may 
further  vary  these  forms  by  the  exclusion  or  diminution 
of  their  oxygen  supply,  or  by  otherwise  altering  their  en- 
vironment. He  will,  moreover,  find  that  the  fresh  blood 
serum  may  be  introduced  into  the  veins  of  an  animal 
without  causing  any  mischief,  while  that  in  which  the  new 
bacteria  have  developed  will,  according  to  their  stage  of 
development,  set  up  the  most  violent  of  blood  maladies. 

We  are,  however,  not  concerned  just  now  with  the  ori- 
gin of  blood  disease,  but  only  with  the  tendency  to  break 
down  prcinaturoly,  under  ordinary  work  and  with  ordi- 
nary food,  which  so  many  people  of  the  present  day  ex- 
hibit, and  which  they  have  inherited  from  their  ancestry. 


ORIGIN    OF   FEEBLE    DIGESTION.  241 

It  will  nearly  always  be  remarked  that  the  unfortunate 
possessors  of  enfeebled  digestive  organs  start  life  appar- 
ently well,  and  generally  exhibit  no  sign  of  any  special 
weakness  till  after  puberty.  Then,  perhaps  at  twenty-five 
years  of  age,  perhaps  not  till  ten  or  twenty  years  later,  in 
any  ease  prematurely,  one  organ,  usually  the  liver,  begins 
to  hang  out  signs  of  distress  in  the  shape  of  biliousness, 
gout,  rheumatism,  gall-stone  formation,  etc.;  the  weakest 
organ  is,  in  fact,  most  rapidly  coming  to  the  end  of  its 
stock  of  vitality — its  capital  in  which  was  small  at  birth 
— and  is  exhibiting  early  in  life  the  signs  that  appertain, 
in  a  stronger  organ,  only  to  old  age. 

The  patient  is  often  loud  in  his  complaints.  What,  he 
asks,  has  he  done  to  merit  this  disaster  ?  He  may  have 
done,  in  ignorance,  a  good  deal  towards  it,  or  nothing; 
may,  in  fact,  have  simply  inherited  it  from  his  ancestors, 
as  he  inherited  their  other  traits.  It  does  not  matter  very 
much,  however,  what  the  precise  cause;  the  derangement 
is  before  him,  and  he  has  to  face  it.  Now  the  key-note  of 
treatment  in  these  cases  is  economy.  The  organ  or  organs 
of  digestion  have  some  power  left.  He  must  cut  down 
and  simplify  the  food  and  make  this  residue  of  power  to 
sufiice  for  as  long  as  possible.  "I  am  well  enough,  now 
that  I  have  consented  to  be  always  ill,"  said  Gustave 
Flaubert,  and  in  this  sentence  lies  the  whole  philosophy 
of  life  for  the  dyspeptic.  Such  a  one  is  the  shorn  lamb 
to  whom  the  wind  must,by  artificial  means,  be  tempered. 
Clothing,  climate,  and,  above  all,  food,  must  be  nicely  ad- 
justed to  his  bodily  needs,  for  only  under  those  conditions 
can  he  be,  and  remain,  well. 

But  we  know  that  the  digestive  function  is  contermi- 
nous only  with  the  body,  and  thus  indigestion,  while  gen- 
erally more  marked,  more  demonstrative,  in  some  organs, 
such  as  the  stomach  and  liver,  than  in  others,  such  as  the 
11 


242  DISEASES    DUE    TO    UNSUITABLE    FOOD. 

blood-vessels,  is  therefore  in  every  sense  of  the  word  a 
general,  and  in  no  sense  a  local,  disorder.  And  therefore 
the  following  directions  will  be  found  suitable  for  most 
cases  of  chronic  ill-health  and  debilitv,  even  if  such  have 
no  apparent  causation  in  defective  digestive  power. 

The  subjects,  then,  of  ^02^^,  rheumatism,  glucosuria  (de- 
pendent on  liver  derangement),  BrighVs  disease,  functional 
albuminuria,  biliousness,  gall-stone,  and  any  form  of  chronic 
nervous  or  jyhysical  disorder,  should,  unless  there  be  some 
very  special  contraindication,  observe,  as  regards  food,  the 
following  rules: 

Avoid  frequent  and  mixed  meals,  especially  the  excessive 
consumptio7i  of  meat. 

After  thirty  years  of  age,  two  full  meals  a  day  usually 
suffice. 

Brealfast  may,  unless  there  be  present,  as  in  gastric  ca- 
tarrh, much  morning  nausea,  be  a  full  meal,  for  very  rarely 
does  dyspepsia  follow  in  the  wake  of  breakfast,  for  the  stom- 
ach comes  to  this  meal  rested  and  reinvigorated  by  sleep 
and  also  completely  empty.  Another  great  reason  why  the 
first  meal  of  the  day  is  usually  for  the  dyspeptic  the  most 
satisfactory  one  is,  that  the  nervous  system,  itself  supplied 
and  kept  in  due  action  by  food,  watches  over  and  regu- 
lates the  digestive  acts,  and  this  system  is  also  in  the 
morning  at  its  best  and  freshest.  Breakfast,  then,  may 
be  a  liberal  meal.  A  little  porridge  and  milk,  followed 
by  fish  or  bacon,  bread  or  toast  and  abundance  of  butter, 
and  concluded,  if  possible,  with  a  little  ripe  fruit,  makes 
generally  an  excellent  form  of  repast.  Coffee  and  milk, 
half  and  half,  is  the  best  beverage,  but  there  is  generally 
no  objection  to  be  raised  to  the  substitution  for  it  of  tea, 
cocoa,  or  even  of  some  light  natural  wine  well  diluted. 

Midday  Meal. — Few  busy  men  who  have  to  work  with 
their  nervous  systems  can,  without  great  risk  of  either 


SIMPLE    DIET    RULES    IX    DYSPErSIA.  243 

painful  indigestion  or  of  subsequent  temporary  diminution 
of  brain  power,  as  shown  by  drowsiness,  take  with  safety 
a  heavy  midday  meal. 

A  few  plain  biscuits  and  butter,  with  one  or  two  cups  of 
coffee,  form  for  such  people  an  adequate  midday  meal.  If 
more  food  be  desirable,  then  a  little  plain  boiled  fish  or 
a  few  sandwiches  may  be  substituted,  and,  if  constipation 
be  a  source  of  trouble,  a  little  fruit  may  afterwards  be 
consumed. 

Dinner. — This  meal  should  be  taken  not  only  after  the 
day's  work  has  been  done,  but  after  it  has  been,  if  possi- 
ble, al^o  forgotten. 

No  one  can  digest  a  full  meal  with  trouble  or  anxiety 
on  his  mind,  or  even  immediately  after  great  physical  ex- 
ertion. The  patient  must  remember  that  he  does  not 
bring  to  this  meal,  as  he  did  to  breakfast,  a  reinvigorated 
nervous  system,  but  one  that  is  more  or  less  exhausted  by 
the  occupations  of  the  day.  He  should  therefore,  if  pos- 
sible, get  a  little  rest  between  the  termination  of  the  day's 
labor  and  his  dinner,  and  divert  his  current  of  thoughts 
into  pleasant  channels.  If  he  cannot  do  this,  cannot  shake 
off  the  worries  and  fatigues  of  the  day,  he  must  be  con- 
tented to  make  a  very  frugal  repast;  there  is  no  other 
wise  alternative. 

Dinner  is  a  meal  that  may  take  so  many  forms,  and  be 
eaten  under  such  different  conditions,  that  I  shall  confine 
my  remarks  to  one  or  two  general  hints  only. 

The  dyspeptic,  as  a  rule,  will  do  well  to  shun  soup.  It 
does  not  wash  away  or  dilute  the  digestive  fluid;  that  is 
a  superstition  to  which  nobody  with  the  least  knowledge 
of  the  functions  of  the  stomach  will  subscribe,  but  a  large 
quantity  of  warm  fluid  can  debilitate  the  muscular  coat  of 
the  organ,  and  on  the  contractile  powers  of  that  coat, 
quite  as  much  as  on  the  amount  of  gastric  fluid,  depends 


244  DISEASES   DUE   TO    UNSUITABLE    FOOD. 

perfect  digestion.  However,  be  its  influence  what  it  may, 
experience  is  fairly  unanimous  in  its  condemnation  of 
soup.  Both  fish  and  meat  may  be  taken.  Vegetables, 
with  one  exception,  may  be  freely  consumed  as  a  general 
rule,  though  I  am  strongly  of  opinion  that  bread  or  toast 
only  should  be  eaten  with  meat  and  fish,  vegetables  fol- 
lowing as  a  separate  course.  The  one  exception  in  vege- 
tables is  the  potato.  This  tuber  consists  very  largely  of 
starch,  and,  as  ordinarily  served  up,  of  starch  but  partly 
cooked.  Nor  boiling,  nor  baking,  nor  frying  can  gener- 
ally suflSce  to  rupture  completely  its  starch  grains;  pro- 
longed roasting  alone  can  effect  that,  and  roasted  potatoes 
alone  are  therefore  digestible.  The  test  of  comjjlete  cook- 
ing in  the  potato  is  the  measure  of  its  mealiness,  for 
all  starchy  foods  when  thoroughly  cooked  tend  to  fall  to 
pieces.  For  this  reason  bread  cannot  be  made  from  maize- 
meal,  barley-meal,  or  oatmeal,  while  it  can  be  from  wheat- 
meal  and  rye-meal,  as  these  substances  contain  a  special  sub- 
stance called  gluten,  which  binds  together  the  starch  grains. 

With  regard  to  sweets,  most  dyspeptics  w^ill  do  well  to 
avoid  pastry  and  puddings,  even  milk  puddings.  Stewed 
fruit  and  cream  may  be  taken,  and  to  a  snack  of  ripe 
cheese  there  is  no  objection.  Ripe  fruit  may  often  bene- 
ficially conclude  the  meal. 

The  beverage  at  dinner  is  a  difficult  matter  to  settle. 
Water  is  undoubtedly  the  best,  but  a  little  Rhenish  or 
Moselle  wine,  or  a  light  claret  or  Burgundy,  well  diluted 
with  a  plain  or  sparkling  water,  may  be  usually  allowed. 
Cider  is  sometimes  a  permissible  beverage,  even  for  gouty 
patients. 

LaU  Meal. — No  further  meal  is,  in  the  majority  of 
cases,  necessary  after  a  late  dinner.  If  one  be  necessary, 
it  should  be  light  and  digestible,  and  consist  of  a  farina- 
ceous pudding  or  of  a  few  biscuits. 


SIMPLE    DIET    RULES    IN   DYSPEPSIA.  245 

Of  course  many  exceptions  may  justly  be  taken,  in  in- 
dividual cases,  to  even  such  a  limited  diet  scale  as  that 
which  I  have  here  sketched,  nor  do  I  recommend  that 
much  weight  be  attached  to  the  restrictions,  either  in 
amount  or  kind,  of  any  set  dietary.  The  great  facts 
which  the  dyspeptic  has  to  bear  in  mind  are  that  diges- 
tion depends  very  largely  upon  the  state  of  his  nervous 
system,  and  that  therefore  it  is  important  to  come  to  each 
meal  as  light-hearted  as  possible;  that  six  or  eight  hours 
at  least  should  elapse  between  any  two  heavy  meals;  that 
the  demands  of  the  body,  in  the  way  of  meat,  are  less  as 
life  advances;  that  the  demand  for  other  foods  diminishes 
also  in  proportion  to  age  and  to  the  smallness  of  the  daily 
toil;  and  that,  lastly,  an  adequate  supply  of  oxygen  is  nec- 
essary to  burn  the  fuel-foods,  and  of  muscular  movement 
to  remove  the  final  debris  of  food  from  the  body;  to  se- 
cure which  two  desiderata  he  must  each  day  take  a  rea- 
sonable amount  of  outdoor  exercise,  or,  by  preference, 
outdoor  amusement. 

One  is  constantly  asked  about  the  digestibility  of  fat,  of 
starch,  of  sugar,  of  infusions  of  tea,  of  raw  A^egetablcs,  of 
pastry,  of  cheese,  and  especially  as  to  the  utility  of  alco- 
hol. I  will  briefly  touch  on  the  virtues  and  the  vices  of 
these  substances. 

Fat. — The  sole  destiny  of  fat  in  the  body  is,  in  conjunc- 
tion with  oxygen  drawn  in  by  the  lungs,  to  undergo  com- 
bustion and  supply  heat. 

The  above  aphorism,  first  enunciated  by  Liebig,  is  strict- 
ly true,  but  it  does  not  comprise  the  whole  truth. 

Indirectly,  fat,  like  gelatine,  while  it  cannot  replace 
albumen,  can  economize  it.  Thus,  Dr.  Germain  See  found 
that  a  dog  fed  on  1200  grammes  of  lean  meat  a  day  still 
lost  steadily  a  little  of  the  albuminous  material  of  his 
body,  while  the  same  animal  on  500  grammes  of  meat 


246  DISEASES    DUE    TO    UNSUITABLE    FOOD. 

and  200  grammes  of  fat  kept,  to  use  Dr.  See's  expression, 
his  nutrition  account-book  balanced.  Rubner's  exj^eri- 
ments  on  man  led  to  a  similar  conclusion.  He  found  that 
one  who  consumed  1435  grammes  of  lean  meat  a  day, 
containing  48.8  grammes  of  nitrogen,  lost  daily  by  the 
kidneys  50.8  grammes  of  nitrogen,  while  on  400  grammes 
of  fat  and  less  than  700  grammes  of  lean-  meat,  the  nutri- 
tive balance  between  intake  and  output  of  nitrogen  was 
restored. 

Fat  is,  then,  when  once  the  stomach  has  been  passed,  a 
substance  easy  of  digestion  and  a  potent  economizer  of  al- 
bumen, that  food  material  most  difficult  of  digestion,  and 
whose  mal-digestion  leads  to  a  long  array  of  grave  degen- 
erations. 

Now,  for  the  reasons  just  given,  it  is  evident  that  the 
gouty,  the  rheumatic,  the  albuminuric,  the  bilious,  the  dys- 
peptic of  every  grade,  all  of  whom  have  great  difficulty  in 
the  final  digestion  of  albuminoids,  ought  to  partake  freely 
of  fat,  and  yet  these  are  precisely  the  individuals  who  find 
that  fat  disagrees  with  them,  and  we  have  in  the  above 
facts  a  clue  to  the  reason  underlying  their  objection  ;  for 
it  is  evident  that  if  fat  be  freely  taken  in  a  dietary  already 
too  rich  in  albuminoids,  it  must  aggravate  the  disorder, 
while  if  the  fat  selected  be  one  specially  prone  to  undergo 
fermentation,  and  if  it  be  consumed  in  company  with  a 
heavy  meat  and  starchy  supply,  it  is  quite  conceivable 
that,  in  an  already  debilitated  stomach,  it  may  undergo  a 
rapid  conversion  into  that  highly  offensive  and  irritating 
fatty  acid  called  butyric  acid.  Now,  it  is  this  tendency  of 
fat  to  undergo  fermentation  and  to  change  into  butj^ric 
acid,  in  short,  to  become  rancid,  which  has  first  to  be 
guarded  against,  and  when  this  difficulty  has,  by  a  little 
management,  been  overcome,  then  the  variety  of  patient 
of  which  I  have  spoken  will  speedily  be  convinced  by  his 


USES    OF    FAT.  24Y 

own  feelings  that  a  liberal  supply  of  fat,  and  a  decreased 
amount  of  meat,  conduce  very  powerfully  to  bis  general 
well-being. 

To  pass  the  feeble  stomach  with  comfort,  fat  must  be 
digestible,  fresli,  cold,  and  not  taken  with,  or  combined  in, 
indigestible  admixtures. 

Well-made  fresh  butter  stands  first  in  the  order  of  di- 
gestible fats,  then  conies  bacon  fat,  then  cold  beef  or 
mutton  fat,  then  cream.  Besides  these  we  have  the  easily 
assimilated  pancreatic  fat  emulsions  in  the  market,  and 
the  somewhat  distasteful,  but  often  very  useful,  cod-liver 
oil. 

Fat  in  any  of  the  following  forms  should  be  shunned  : 
When  it  is  hot ;  when  it  is  not  only  hot,  but  mixed  with 
sauces,  condiments,  and  other  substances,  as  in  ragouts, 
etc. ;  when  it  is  not  quite  fresh  ;  Avlien  it  is  mixed,  as  in 
pastry,  with  flour,  and  the  flour  is  but  partially  cooked  ; 
when  it  is  mixed  with  flour,  sugar,  currants,  etc.,  in  cakes. 
The  two  latter  substances — pastry  and  sweet  cakes — are 
often  subject  to  the  further  objection  that  the  butter  used 
in  their  construction  is  not  of  the  freshest.  Finally,  fat 
must  not  be  consumed  in  large  quantities  if  a  large  and 
somewhat  indigestible  admixture  of  meat*  and  farinace- 
ous pudding  already  occupies  the  stomach. 

Starch. — Many  gouty  and  dyspeptic  people  are  exceed- 
ingly chary  of  consuming  potatoes  and  farinaceous  pud- 
dings, while  they  partake  of  bread  and  toast  freely.  There 
are  two  reasons  that  account  for  this  distrust.  In  the  first 
place,  the  starch-grains  in  potatoes  are  rarely  thoroughly 
cooked,  the  same  being  true,  but  to  a  less  extent,  of  most 
farinaceous  puddings,  which  to  be  easy  of  digestion  should 
not  contain  eggs,  which  tend  to  bind  together  the  stareh- 

*  It  is  also  to  be  remembered  that  when  overmuch  meat  is  con- 
sumed fat  tends  to  aggravate  all  the  consequences  of  such  excess. 


248  DISEASES    DUE    TO    UNSUITABLE    FOOD. 

grains,  and  should  be  slowly  cooked  ;  and,  in  the  second 
place,  it  is  evidently  likely  to  over-tax  a  weak  liver  to 
compel  it  to  deal  at  the  same  time  with  both  the  albu- 
minoids of  the  meat  and  the  grape-sugar  resulting  from 
the  conversion  of  starch. 

Sugar. — Cane-sugar,  like  starch,  appears  in  the  liver  as 
glycogen  and  in  the  blood  as  grape-sugar,  and  therefore 
the  remarks  made  on  starch  apply  equally  to  this  article. 
It  is  not,  however,  in  the  liver,  but  in  the  stomach,  that  the 
dyspeptic,  especially  if  of  the  gouty  type,  experiences  dis- 
comfort after  partaking  of  saccharine  foods.  There  can 
be  no  doubt  that  in  many  cases  sugar  is  regarded,  without 
sufficient  j^roof,  as  apt  to  set  up  acidity.  People  who  take 
highly  sweetened  cafe-au-lait  or  chocolate,  or  those  dys- 
peptics who  partake  of  sweetened  tea,  blame  the  sugar 
only  if  acidity  ensue,  forgetting  that  milk  contains  a  fair 
proportion  of  fat  in  the  form  of  cream,  that  chocolate  is 
even  richer  in  that  substance,  and  that  the  tannin  in  tea 
and  coffee^  though  certainly  not  injurious  to  a  strong 
stomach,  nor  to  one  long  accustomed  to  it — for  the  most 
delicate  in  China  and  in  Australia  drink  large  quantities 
of  tea  with  absolute  impunity — may  nevertheless,  when  in 
conjunction  with  sugar,  turn  the  balance  the  wrong  way. 
Again,  in  pastry  and  sweet  cakes,  sugar  is  often  a  minor 
factor  in  the  resulting  discomfort. 

Still,  after  eliminating  all  such  sources  of  misstatement, 
the  fact  remains  that,  in  some  cases,  plain  sugar  causes 
marked  gastric  acidity.  It  cannot  be  said  that  as  yet  we 
possess  any  perfect  explanation  of  this  phenomenon,  though 
if  the  recent  researches  of  Ellenberger  and  Hofmeister 
{Fortschritte  der  3Iedecin,  June,  1886)  be  confirmed,  that 
grape-sugar  undergoes  a  temporary  change  in  the  stomach 
and  intestines  into  lactic  acid,  it  may  well  be  that  in  states 
of  feeble  digestive  action,  and  when  the  muscular  tone  of 


TEA    IX    STATES    OF    INDIGESTION.  249 

the  stomach  is  impaired,  this  conversion  may  take  place 
almost  completely  and  solely  in  the  former  organ.  Not 
that  the  reader  must  infer  that  lactic  acid  is  to  be  regard- 
ed  as  always  abnormal  when  found  in  the  gastric  contents, 
for  it  is  rare  to  extract  fluid  from  a  stomach  even  in  the 
most  perfect  states  of  health  Avithout  meeting  with  it;  it  is 
only  an  excessive  amount  thereof  which  can  cause  serious 
digestive  impediment. 

Tea. — In  dealing  with  such  a  subject  as  tea,  about  which 
so  much  that  is  useful,  and  so  much  more  that  is  nonsensi- 
cal, has  been  written,  I  shall  confine  myself  to  a  very  brief, 
pro  and  con,  summary. 

In  persons  of  robust  digestion  tea  may,  ^yith.  impunity, 
be  partaken  of.  In  delicate  people  the  following  precau- 
tions must  be  observed.  It  must  be  fresh  ;  not  taken  ex- 
cept after  or  towards  the  end  of  a  meal,  for  all  hot  fluids 
poured  into  a  flabby,  non-contracted  stomach  have  the  nat- 
ural effect  of  drawing  gases  from  the  intestine  through  the 
relaxed  pyloric  orifice.  It  should  be  taken  in  moderation, 
four  to  six  tea-cups  per  day  being  the  outside  limit.  If 
with  such  precautions  it  still  disagrees,  tea  may  be  taken 
without  milk,  w-ith  little  sugar,  and  with  an  addition  of 
ten  drops  of  lemon-juice  to  each  cup  ;  or  to  each  cup  of 
tea,  sugar,  and  milk  may  be  added  a  very  small  pinch  of 
bicarbonate  of  sodium. 

Cold  or  iced  tea — that  is,  an  infusion  of  tea  that  has 
been  poured  into  a  receptacle  as  soon  as  it  has  been  made 
and  there  left  to  get  cool — even  when  consumed  in  very 
large  quantities  and  by  delicate  people,  rarely  disagrees. 

Tannin,  the  bogie  of  the  glass-tube  experimentalist,  is 
not  the  source  of  the  discomfort  that  is  observed  after 
drinking  a  w^ell-made  infusion  of  tea.  Coffee  contains, 
according  to  such  excellent  observers  as  Stenhouse,  Roch- 
leder,  Mulder,  and  Konig,  a  nearly  equal  amount  of  this 


250  DISEASES    DUE    TO    UNSUITABLE    FOOD. 

substance,  and  the  red  wines  of  Bordeaux  and  of  the  Cote 
du  Rhone  may  be  said,  considering  the  relative  quantity 
consumed,  to  contain  much  more,  while  against  none  but 
tea  lias  the  charge  of  tannin-poisoning  been  raised.  In 
fact,  tannin  is  one  of  the  commonest  ingredients  in  nat- 
ure, and  must,  from  the  earliest  times,  have  been  partaken 
of  daily  by  almost  every  human  being,  and  such  a  sub- 
stance cannot  readily,  even  if  consumed  somewhat  in  ex- 
cess, become  deleterious.  Sometimes,  indeed,  a  slight  ex- 
cess of  tannin  acts  as  a  direct  stimulant  to  digestion,  and 
Peruvian  bark  owes  largely  to  this  ingredient  its  power 
of  temporarily  bracing  up  the  digestion  and  the  whole 
body. 

The  question  of  the  suitability  of  raw  vegetables  in  states 
of  indigestion  will  need  but  a  brief  notice.  Lettuce  and 
water-cress  alone  may  thus  be  eaten  with  safety. 

Cheese,  like  eggs  and  all  other  varieties  of  concentrated 
food,  will  often  disagree,  but  its  digestibility  increases  as 
a  rule  with  its  advance  towards  decay.  This  is  simply 
due  to  the  fact  that  the  adhesiveness  of  the  individual 
particles  lessens  as  the  cheese  ripens. 

To  the  indigestibility  of  pastry  in  most  cases  of  dyspep- 
sia I  have  referred  already. 

Alcohol. — Of  all  the  substances  commonly  entering  into 
the  dietary  of  man  none  is  a  better  example  of  a  food 
often  relatively  improper  than  alcohol.  We  are  fortu- 
nately not  concerned  with  the  burning  question  of  habitual 
alcoholic  excess,  for  we  have  long  since  made  up  our 
minds  that  excess  of  every  kind  is  harmful,  and  we  know 
that  there  are  many  common  articles  of  food — notably  salt 
— even  more  rapidly  fatal  than  is  alcohol  when  the  amount 
consumed  out-measures  considerably  the  physiological  de- 
mand. 


ALCOHOL    AN    INDIRECT    NUTRIMENT.  251 

All  we  require  to  know  is,  briefly,  in  what  cases  alcohol 
may  prove  a  useful  food,  or  adjunct  to  food,  and  in  what 
cases  it  is  inadmissible. 

But,  in  the  first  place,  is  alcohol  entitled  to  the  rank 
of  a  food?  Though  it  undergoes,  without  doubt,  some 
change  in  the  body  by  the  aid  of  the  oxygen  in  the  blood- 
current,  yet  it  cannot  be  said  to  be  a  food  in  the  sense  that 
albumen,  fat,  starch,  and  sugar  are  aliments.  It  is  not  a 
repair  material,  and  it  is  not  a  source  of  heat  or  of  force. 
In  fact,  its  position  is  almost  unique,  for  it  plays  the  role 
of  a  brake  applied  to  the  wheels  of  life,  arresting  the  ox- 
idation of  the  other  foods,  and,  hence,  the  wear  and  tear 
of  the  tissues.  But  since  the  chemical  interaction  of  cell 
and  albumen  is  life,  and  the  union  of  oxygen  and  fuel  in 
the  body  is  the  source  of  heat  and  motion,  surely  a  check 
put  on  these  processes  is  equivalent  to  a  mischievous  in- 
terference with  useful  vital  processes.  This  is  indeed  so, 
and  therefore,  unless  the  amount  consumed  be  very  small 
and  be  well  admixed  with  other  substances  of  dietetic  use, 
and,  furthermore,  unless  habit  has,  as  it  can,  made  of  even 
this  small  daily  quantum  of  alcohol  one  of  the  ordinary 
conditions  of  life,  alcohol  must  be  condemned  as  a  dele- 
terious substance  for  a  healthy  man,  at  any  period  of  life, 
to  consume. 

But,  to  be  entitled  to  take  rank  as  a  nutritive  aid,  the 
daily  consumption  of  alcohol  must  be  confined  to  strict 
limits,  for,  since  it  lessens  the  oxidation  of  the  foods,  it 
must,  and  does,  also  decrease  the  heat  of  the  body,  and 
for  the  same  reason  it  promotes  the  deposition  of  the  un- 
burned  fuel-foods  in  the  body  in  the  form  of  fat,  is,  in  short, 
one  of  the  most  common  causes  of  obesity.  Therefore  at 
once,  and  even  in  the  absence  of  other,  strongly  confirma- 
tive, social  facts,  patent  to  every  one,  we  are  compelled 
to  admit  that,  unless,  as  I  have  already  said,  kept  in  check 


252  DISEASES    DUE    TO    UNSUITABLE    FOOD. 

by  habit  and  by  a  very  restricted  consumption,  alcohol  is 
more  of  a  harmful  than  beneficial  agent,  its  sole  nutritive 
virtue  beins^  of  a  nes^ative  character. 

But  alcohol  is  rarely  taken  with  the  i^urpose  of  increas- 
ing weight,  and  still  less  often  with  that  of  reducing  bodily 
heat ;  in  its  stimulating  effects  on  the  body  at  large,  and 
particularly  on  the  brain,  lie  the  great  temptations  to  over- 
use. Furthermore,  to  maintain  the  stimulating  effect  and  to 
anticipate  reaction,  the  dose  must  steadily  increase.  AVhat 
must  be  the  end  of  such  a  course  ?  Premature  breakdown 
(fibrous  degeneration)  of  the  heart,  the  arteries,  the  liver, 
and  the  kidneys,  leading  to  a  general  impairment  of  nutri- 
tion, masked  for  a  long  time  by  that  tendency  to  the  de- 
posit of  fat  which  gives  to  the  drunkard  often  the  appear- 
ance of  health  and  vigor  when  the  vital  organs  are  actually 
tottering  on  the  verge  of  final  collapse.  But  the  organ  most 
stimulated,  the  brain,  suffers  most  severely.  Whipped  up 
for  long  by  the  alcohol,  its  functions  may  not  seem  to  suf- 
fer or  may  even  for  a  time  appear  to  improve,  but  it  is 
a  delusive  improvement,  due  to  the  prodigal  exhaustion 
of  capital,  of  brain-cell  vitality.  The  approaching  bank- 
ruptcy of  this  organ  becomes  sooner  or  later  so  clear  as 
to  be  no  longer  capable  of  concealment  from  the  least 
observant,  and  the  failure  of  its  will  and  control  func- 
tions reduces  the  sufferer  to  little  more  than  an  autom- 
aton. 

But  we  have  no  right,  because  the  si:)ectacle  presented 
by  excess  is  shocking  and  frequently  witnessed,  to  shut 
our  eyes  to  the  fact  that  small  amounts  of  alcohol  possess 
qualities  which  may  be  turned  to  useful  account  in  dis- 
ease, and  Avhich,  within  certain  limits,  are  incapable  of 
harming  a  man  in  health,  nor  is  there  any  sound  logic  in 
an  argument  which,  by  calling  alcohol  unnatural,  seeks  to 
beg  the  whole  question,  for  that  only  is  natural  to  man  to 


THE    USES    OF    ALCOHOL.  253 

wliicli  Ills  body,  witlioiit  deterioration,  can  become  babitu- 
atecl,  and  it  is  abundantly  evident  from  the  past  history  of 
the  world  that  to  alcohol,  in  certain  proportions,  man  can 
become  so  acclimatized  as  to  gradually  overcome  even  the 
tendency  to  obesity  and  the  decrease  of  heat  which  are  the 
first  and  invariable  signs  of  its  influence  on  bodies  to  which 
it  holds  the  position  of  a  new  force. 

But  we  must  not  be  enticed  further  than  is  necessary 
for  our  purpose  into  a  disquisition  on  this  subject  ;  we 
now  know  enough  to  draw  the  following  conclusions. 

Alcohol,  in  restricted  quantities,  of  the  ethylic*  form, 
and  taken  diluted  and  preferably  admixed  with  other 
foods,  becomes  an  actual  agent  in  the  maintenance  of 
health  in  those  acclimatized  to  it  by  heredity  or  habit. 
In  such  it  cannot,  any  more  than  any  other  factor  in  the 
environment,  be  omitted  without  inducing  some  derange- 
ment. In  the  young  and  strong,  in  those,  in  short,  whose 
bodies  i)Ossess  a  high  degree  of  adaptability,  it  may,  how- 
ever, be  dispensed  with  at  any  time,  and  the  derangement 
produced  by  its  sudden  discontinuance  will  be  but  slight 
and  transient,  the  body  soon  fitting  itself  to  altered  con- 
ditions ;  in  the  debilitated  and  old,  and  in  all  those  who 
have  a  difficulty  in  maintaining  equilibrium  or  health,  it 
cannot,  without  risk  of  serious  disorder,  be  suddenly  cut 
off,  and  in  the  rare  cases  where  its  discontinuance  is  plain- 
ly necessary,  the  process  must  be  carried  out  slowly  and 
cautiously. 

In  some  conditions  of  ill-health,  especially  in  those 
states — of  which  we  have  an  example  in  the  early  stage  of 
consumption — where  it  is  difficult  or  im])ossible  to  keep 
up  the  balance  between  the  absorption  of  ordinary  nutri- 

*  There  are  many  alcohols:  ethylic  alcohol  is  apparently  the  only 
one  to  which  the  human  body  can  become,  without  disorder,  habit- 
uated. 


254  DISEASES    DUE    TO    UNSUITABLE    FOOD. 

tives  and  the  necessary  waste  of  tissue,  alcohol  is  a  most 
potent  auxiliary  food  agent.  Wisely  used  in  such  emer- 
gencies, it  can  actually  arrest  that  process  of  going  stead- 
ily to  the  bad  which  soon  places  the  sufferer  beyond  all 
human  aid,  all  chance  of  cure.  It  stops  the  leak,  enabling 
the  body  to  hold  its  ground  till  substantial  aid  of  other 
kind  is  forthcoming.  The  form  it  may  then  take  will  de- 
pend upon  the  digestive  capacity,  and  a  misjudgment  in 
this  respect  may  turn  a  benefit  into  a  disaster.  In  most 
cases  a  light,  natural  wine,  preferably  red,  is  indicated. 
Red  Rhine  wine.  Burgundy,  or  sound,  full-bodied  Bor- 
deaux, or  even  Australian,  Cape,  or  Greek  wine,  may  be 
selected,  according  to  idiosyncrasy  or  to  special  indica- 
tions. If  the  digestive  capacity  be  weak,  a  white  wine 
must  be  substituted.  The  daily  amount  necessary  to  the 
purpose  will  vary  in  each  case,  and  must  be  judged  of 
partly  by  our  own  observation  of  the  effects  witnessed, 
and  partly  by  the  sensations  of  the  consumer.  Port,  long 
in  wood,  is  sometimes  very  useful,  and  even  old  bottled 
Port,  Madeira,  Tokay,  Constantia,  Bucellas,  and  Chateau 
d'Yquem  may  in  some  cases  be  taken  with  greater  benefit 
than  the  lighter  wines.  Sometimes  stout,-old  ale,  or  light 
beer  will  do  more  good  than  wine,  or  a  small  quan- 
tity of  some  spirit,  old  brandy  or  whisky,  may,  with 
greater  advantage,  be  taken  in  milk  two  or  three  times 
a  day. 

It  is  almost  unnecessary  to  add  that  alcohol  may  be  of 
considerable  use  as  a  food  adjunct  in  fever,  for  that  is, 
par  excellence,  a  state  in  which  the  drain  on  the  tissues  is 
great.  Much  of  the  discredit  attaching  to  the  employ- 
ment of  alcohol  in  fever  is  due  to  the  utter  carelessness, 
to  the  habits  of  brainless  routine,  which  mark  its  employ- 
ment, especially  in  hospitals.  The  actual  waste  of  the 
body  must  first  be  approximately  gauged  ere  anything 


THE    USES    OF    ALCOHOL.  255 

else  is  done  and  the  dose  be  proportioned  to  it.  The 
amount  required  will  often  be  extremely  small;  a  tea- 
spoonful  of  brandy  every  three  hours  is  usually  ample. 
But  this  restricted  dosage  does  not  satisfy  the  young  med- 
ico thirsting  for  distinction,  a  tablespoonful  or  more  must 
be  administered  frequently,  till  in  fact  the  results  of  the 
brandy  are  manifest  to  every  sense  in  a  slower,  fuller 
pulse,  a  return  of  light  to  the  partially  obscured  conscious- 
ness, a  moistening  of  the  dry,  parched  tongue,  a  general 
and,  at  first  sight,  most  satisfactory  vivification  of  the  pa- 
tient. Then  a  paean  of  victory  is  chanted,  alas !  often  to 
be  changed  to  a  lament  for  the  dead.  The  small  balance 
of  life  in  the  poor  sufferer,  that  which  it  was  the  duty  of 
the  medical  man  to  husband  for  the  days  of  trial  j^et  in 
store,  has  been  madly  whipped  up  to  make  a  temporary 
flare  ;  there  is  simply  no  more  behind  it.  But  such  reck- 
less foolhardiness,  which  is  what  the  public,  judging  by 
their  experience,  comprehend  as  the  treatment  of  fever  by 
stimulants,  is  utterly  opposed  to  the  wise  and  scientific 
application  of  alcohol  as  a  brake  on  the  downward  path  of 
the  fever -stricken.  We  want  no  stimulation;  we  dread 
it;  we  know  the  penalty  that  must  be  paid  for  it.  All 
we  seek  is  to  place  a  check  on  the  constant  drain  of  tissue 
that  is  endangering  the  life  of  the  patient,  and  this  can 
only  he  done  by  a  small  dose.  This  point  must  be  grasped, 
and  it  must  not  for  a  moment  be  thought  that  it  rests  on 
the  unsupported  ipse  dixit  of  the  author.  Let  the  doubter 
listen  to  the  opinion  of  one  of  the  most  eminent  and  most 
truly  scientific  dietetists  of  the  day.  Dr.  Germain  See,  of 
Paris.  "  By  the  aid  of  alcohol,  as  of  fat,  urea  diminishes, 
and,  as  a  consequence,  the  bodily  weight  increases ;  the 
tendency  of  even  moderate  drinkers  to  obesity  is  well 
known.  It  is  only  v^hen  the  dose  of  alcohol  is  considerable 
that  the  elimination  of  urea  becomes  stationary  or  even 


256  DISEASES    DUE    TO    UNSUITABLE   FOOD. 

finds  itself  increased.  Thus  one  may  say  that  alcohol, 
like  fat,  is  a  means  of  economy  for  the  organism;  a  veri- 
fication of  the  doctrine  of  Von  Voit  on  the  conservative 
action  of  certain  substances  in  common  use  "  ("  Regime 
Alimentaire,"  p.  14G,  Paris,  1887). 

Thus  we  possess  in  alcohol  a  most  useful  agent,  by  the 
use  of  which  the  intake  and  the  output  of  the  body  may 
be  balanced  vvhen  other  means  cease  to  avail. 

Doubtless  the  reader,  accustomed  to  the  ordinary  hand- 
books, will  be  not  a  little  dissatisfied  to  find  that  I  do  not 
attempt  more  precise  directions  as  to  the  amount  and  the 
kind  of  alcohol  suitable  for  each  class  of  derangement.  It 
is  the  fashion,  and  a  most  mischievous  one,  to  regard  each 
disease  as  a  separate  entity,  to  be  dealt  with  on  certain 
fixed  scientific  lines.  People  speak  of  gout  as  if  it  existed 
in  concrete  form.  Practically  there  is  no  such  thing  as 
gout,  but  there  is  often  to  be  seen  in  this  country  the 
spectacle  of  a  gouty  man,  and  it  is  emphatically  the  man 
and  not  the  gout  that  has  to  be  treated.  How  bitterly 
does  the  newly  fledged  practitioner  recognize  this  fact. 
His  treatment  of  gout  is  perfection,  he  can  repeat  the  ip- 
sissima  verba  of  the  text-books,  but  he  is,  nevertheless,  oft- 
en at  sea  when  in  presence  of  a  gouty  individual.  The 
difference  between  the  two  is  a  very  real  one.  The  books 
recognize  but  two  or  three  varieties  of  gout,  but  each 
gouty  man  is  a  variety  in  himself,  simply  because  he  is  a 
man  differing  in  many  points  from  all  other  men,  and  he 
demands  treatment  as  a  separate  variety.  Furthermore, 
the  treatment  suited  to  his  case  to-day  may  not  be  that 
which  proved  serviceable  to  him  ten  years  ago,  for  he  has 
since,  by  change  in  his  tissues,  become,  to  all  intents  and 
purposes,  a  different  man.  It  is  precisely  because  the 
truth  of  these  facts  obtrudes  itself,  often  so  unpleasantly, 
on  myself  as  a  medical  man,  that  I  feel  unable  to  pledge 


RULES    FOR    THE    CONSUMPTION    OF    ALCOHOL.         257 

nivfiolf  in  any  directions  as  to  alcohol  to  more  than  the 
few  followinf?  creneral  facts: 

(a)  The  coDsumption  of  alcohol  in  health,  for  the  sake 
simply  of  the  stimulation  it  affords,  is  dangerous,  for  it 
generally  leads  to  over-indulgence. 

(b)  Persons  habituated  to  the  use  of  small  quantities 
need  not  discontinue  the  consumption,  especially  if,  after 
a  fair  trial  of  abstinence,  they  do  not  remark  an  improve- 
ment in  their  general  health. 

(c)  Concentrated  alcoholic  fluids  should  never  be  con- 
sumed; their  effect  on  the  stomach  lining  is  that  of  a 
caustic,  and  most  pernicious.  It  is,  moreover,  well  to 
confine  the  drinking  of  alcohol  to  meal-times. 

(d)  Certain  combinations  of  alcohol,  not  on  account  of 
the  alcohol,  but  of  its  admixture  with  other  ingredients, 
must,  as  a  rule,  he  shunned  by  all  dyspeptics,  whether 
they  be  gouty,  rheumatic,  glucosuric,  neurotic,  or  what 
not.     They  are  as  follows: 

N'ew  and  highly  fortified  wines. 

Champagne,  especially  if  sweet. 

Light  natural  wines  that  have  begun  to  alter  (to  under- 
go acetous  fermentation). 

Spirits,  such  as  rum,  containing  much  unfermented 
suQ-ar. 

The  heavier  malt  liquors  —  e.  (/.,  old  ale,  stout,  heavy 
beers. 

In  rum,  and  sweet,  fortified  new  wines,  such  as  are  most 
ports  and  sherries,  and  in  sweet  champagne,  the  ingredient 
which  hampers  digestion  is  mainly  the  unfermented  sugar 
present,  that  undergoes  a  very  rapid  and  premature  meta- 
morphosis into  lactic  acid  upon  reaching  the  stomach,  de- 
ranging the  whole  digestive  process  in  that  organ,  and 
thus  favoring  various  other  fermentations.  In  badly  kept 
light  wines,  acetic  acid,  or  vinegar,  is  often  present,  or  if 


258  DISEASES    DUE    TO    UNSUITABLE    FOOD. 

not  actually  existent  at  the  time  of  consumption,  becomes 
soon  developed  in  the  stomach.  In  malt  liquors  of  the 
heavier  kind  there  exist  various  essential  oils,  notably  lu- 
puline  and  hopeine,  real  vegetable  narcotic  poisons,  which 
hamper,  by  their  effects  on  the  nervous  system,  all  the  di- 
gestive acts,  and  are  the  causes  of  that  heaviness  which  so 
often  follows  the  consumption  of  these  beverages.  Well- 
made  and  well-kept  natural  wines  poor  in  alcohol,  well- 
kept  cider,  light  beers,  and  whiskey,  cognac,  and  unsweet- 
ened gin  are,  as  a  rule,  the  only  safe  alcohblic  beverages 
for  the  debilitated,  the  dyspeptic,  and  the  fever-smitten. 

The  Question  of  Dietaries. — Unquestionably  I  shall  be 
held  to  have  shamefully  neglected  my  task  if,  presuming 
to  treat  of  foods,  I  neglect  to  recommend  some  new  diet- 
ary or  some  novel  arrangement  of  the  older  ones. 

And  yet  I  shall  certainly  make  no  such  effort,  but  shall 
confine  myself  to  the  pointing  out  of  certain  advantages 
and  certain  drawbacks  in  some  of  the  more  prominent 
systems,  a  comprehension  of  which  may  enable  the  reader 
beneficially  to  make  use  of  them  within  wise  limits,  not 
always  indicated  by  their  special  champions. 

For,  after  all,  it  is  very  much  with  a  man's  dietary  as 
with  his  soul,  general  directions  of  rule  and  conduct  can 
only  be  given,  it  being  left  to  his  inward  mentors,  in  the 
first  case  his  judgment,  in  the  second  his  conscience,  to 
adapt  such  directions  to  the  special  requirements  and  con- 
ditions of  his  case.  It  is  true  that  the  smaller  manuals  of 
physiology — forced  by  stress  of  restricted  space  to  be  dog- 
matic in  their  statements — seem  to  countenance  the  feasi- 
bility of  a  set  dietary,  at  least  for  the  healthy  man;  and, 
indeed,  it  is  on  a  study  confined  to  such  elementary  works 
that  the  dietetic  amateurs  of  the  da}',  when  they  conde- 
scend to  give  reasons  for  the  faith  that  is  in  them,  found 
their  arguments ;  but  a  deeper  study  of  the  great  masters 


VEGETARIANISM.  259 

of  physiological  science  fails  to  suj^port  this  view,  and  shows 
rather,  by  the  numerous  exceptions  which  follow  each  state- 
ment, the  great  reluctance  with  which,  when  they  venture 
to  do  so  at  all,  they  lay  down  a  dietetic  rule  of  life. 

Health,  as  I  have  so  often  reiterated,  is  indeed  a  fixed 
and  settled  state,  one  of  balance  between  a  body  and  its 
environment,  but  the  weights  that  form  the  poise  and 
counterpoise  differ  in  each  and  every  case.  When  it  comes 
therefore  to  a  condition  of  ill-health,  to  loss  of  equilibri- 
um, it  is  clear  that  what  may  nicely  suffice  to  restore  a 
])alance  in  one  case,  will,  in  another,  either  have  no  appre- 
ciable or  an  over-powerful  effect. 

Vegetarianism.  —  Among  the  dietetic  competitors  for 
popular  favor  at  the  present  day,  vegetarianism  holds  a 
prominent  place,  and  may  justly  boast  of  influential  and 
able  supporters.  It  is  boldly  claimed  for  it  that  it  is  the 
natural  dietetic  system  of  man,  that  for  which  he  was 
mr.de  and  is  best  fitted;  that  when  adopted,  it,  in  the  vast 
majority  of  cases,  promotes  longevity  and  vigor;  that  it 
clears  the  mind  and  regulates  the  mental  processes ;  that 
it  both  cures  and  prevents  gout,  biliousness,  rheumatism, 
epilepsy,  dyspepsia  of  every  shade,  and  not  a  few  other 
complaints,  and  that  it  is  cheaper  than  a  mixed  dietary. 

Turning  to  geography,  the  vegetarian  points  to  the  vege- 
tarian feeders  of  the  day — the  Arabs,  the  Turkish  porters 
at  Smyrna,  the  Chilian  miners,  the  Russian  peasantry,  all 
examples  of  muscular  strength  and  of  robust  health;  com- 
ing to  history,  the  Greeks  of  Leonidas,  the  Persians  of 
Cyrus,  the  Swedes  of  Gustavus  Vasa,  among  groups  of 
men;  Pythagoras,  Socrates,  Seneca,  Buddha,  St.  Chrysos- 
tom,  Milton,  Byron,  Yoltairc,  Schiller,  and  Linnaeus,  among 
individuals,  are  solemnly  paraded  before  us  as  the  prod- 
ucts of  a  vegetarian  diet;  while  even  comparative  anato- 
my is  pressed  into  the  service,  and  our  near  anatomical 


260  DISEASES    DUE    TO    UNSUITABLE    FOOD. 

relative,  the  monkey,  is  brought  forward  as  a  strict  vege- 
tarian to  shame  or  to  convince  us. 

In  fact,  so  able  have  been  the  advocates  of  this  system, 
and  so  special  their  pleading,  that,  even  in  the  upper  ranks 
of  medicine,  men  of  wide  reading  and  sound  judgment — 
and  not  of  the  common  limpet  order — have  been  enticed 
away ;  while  of  suffering  laity,  legions  of  the  lialt,  the 
maimed,  and  the  blind  have  sought  physical  salvation  in  re- 
nouncing the  flesh  of  all  that  creeps,  runs,  flies,  or  swims. 

A  system  such  as  this,  with  its  pretence  to  a  universal 
application  both  in  health  and  in  disease,  with  its  promise 
to  regenerate  the  race  by  abolishing  poverty  and  reducing 
vice  to  a  minimum,  and  embodying,  it  must  be  added, 
great  truths,  calls  for  some  detailed  attention  and  analysis. 

Like  all  systems  founded  on  a  one-sided  review  of  his- 
tory and  on  limited  and  often  unintentionally  biassed  per- 
sonal observation,  vegetarianism  propounds  great  truths 
of  w^de,  but,  alas  !  not  of  universal  application.  It  speaks 
the  truth,  but  not  the  whole  truth.  It  is,  among  systems, 
a  fine  specimen  of  the  limpet  kind,  but  it  cannot  justly 
claim  to  have  covered  the  whole  rock  of  scientific  truth. 

Let  us  make  an  attempt  to  read  the  riddle  of  its  suc- 
cesses and  its  failures. 

And,  first  of  all,- -what  claim  has  a  vegetarian  dietary  to 
be  considered  the  original  and  only  natural  food  system 
of  mankind  ?  None  whatever,  for,  whenever  we  turn  to  an- 
cient history,  sacred  or  profane,  we  find  among  the  earliest 
records  unquestionable  evidence  that  mankind,  even  with 
unlimited  and  convenient  vegetarian  food  at  his  doors, 
preferred  rather  to  risk  danger  in  the  chase  or  in  the  pro- 
longed night-watching  and  exposure  incurred  by  the  cus- 
tody of  flocks,  with  a  steady  view  to  their  eventual  con- 
sumption, than  to  restrict  himself  in  his  food  to  the  very 
accessible  sources  of  a  purely  vegetable  order.     Again,  if 


VEGETAKIANISM.  261 

we  penetrate  more  deeply  into  the  earlier  evidences  of  hu- 
man life  on  the  globe,  we  find  that  the  manufacture  of 
weapons  by  primeval  man  was  an  early  art,  even  earlier 
than  the  construction  of  utensils  to  be  employed  in  cook- 
ing, and  it  is  difficult  to  believe  that  primitive  man,  when 
he  had  the  good-fortune  to  slay  a  wild  animal,  could  resist 
the  temptation  of  consuming  him,  surrounded  as  he  was 
on  every  side  by  the  evil  example  of  carnivores. 

However,  let  kreophagy  have  commenced  when  and 
how  it  may,  there  is  no  evidence  that  the  practice  was,  or 
is,  a  transgression  of  any  natural  law.  It  is  evident  that 
the  body  soon  accommodates  itself  to  such  food,  the  true 
and  only  test  of  any  material  being  natural,  for  there  is 
no  fixed  standard  in  such  matters — though  a  presumption 
of  such  is  implied  in  the  arguments  of  dietetists — and  in 
food,  as  in  other  conditions  of  life,  the  field  over  which 
mankind  can  wander  without  transgressing  the  bounds  of 
iSTature  is  for  him,  more  than  for  jany  other  animal,  a  wide 
one.  As  to  the  argument  sometimes  advanced  that  the 
vegetarian  who  returns  suddenly  to  a  full  meat  diet  will 
often,  even  generally,  experience  discomfort,  while  its  truth 
may  be  admitted,  proves  nothing,  for  this  is  true  also  of 
the  kreophagist  converted  to  the  vegetarian  system.  When 
you  suddenly  alter  the  weights  in  a  balance  there  will  be  a 
little  oscillation  of  the  arms  before  the  quiet  of  equilibri- 
um is  again  restored,  however  exactly  the  weights  may 
have  been  readjusted. 

Neither,  on  the  second  postulate  advanced,  that  of 
greater  vigor  and  longevity,  is  there  any  proof  of  the  su- 
periority of  an  exclusively  vegetarian  system  over  a  mixed 
diet;  indeed,  the  palm  of  vigor,  of  fitness  to  survive  in 
the  great  and  eternal  struggle  for  existence  on  this  earth, 
would  seem  to  rest  with  the  flesh-eater,  while  on  the  ques- 
tion of  the  greater  prolongation  of  life  on  a  dietary  into 


262  DISEASES    DUE    TO    UNSUITABLE    FOOD. 

which  flesh-food  enters  not,  we  have  absolutely  no  evi- 
dence. Trul}^,  in  certain  religions  communities,  especially 
in  some  that  follow  the  rule  of  the  Catholic  Church,  with 
an  abstinence  from  all  but  vegetable  food,  is  witnessed  a 
vigorous  and  intellectual  old  age.  This,  however,  is 
equally  true  of  other  orders  not  debarred  by  their  rule 
from  meat,  and  cannot  therefore  be  ascribed  solely  to 
their  dietetic  system,  though,  for  reasons  to  be  presently 
given,  it  must  reckon  as  one  of  the  factors  in  the  result, 
but  is  due  rather  to  the  exclusion  of  their  votaries  from 
the  worries  and  dangers  of  life  in  the  world,  and  from  the 
consequent  wear,  tear,  and  misuse  of  brain-tissue,  and  to 
many  other  conditions  favoring  length  of  days. 

That  a  vegetarian  regime  generally  promotes  mental 
clearness,  and  favors  a  calm,  even  j^hilosophical,  frame  of 
mind,  and  that  it  holds  in  great  check  the  passions,  is  true; 
and  that  it  is  a  most  eiScient  means  for  the  prevention  and 
cure  of  gout,  rheumatism,  biliousness,  some  forms  of  epi- 
lepsy, and  most  varieties  of  gastric  and  intestinal  dyspej)- 
sia,  I  think  must  also,  in  justice,  be  conceded  ;  but  this  is 
not  due  alone  to  the  superiority  of  the  vegetable  element, 
but  to  other  easily  traced  causes.  What,  then,  is  the 
rationale  of  the  process — are  the  benefits  derived  durable, 
are  they  ever  purchased  at  grave  risk  to  life  ? 

The  effects  observed  are  the  direct  and  natural  conse- 
quences of  a  diminution  in  the  supply  to  the  body  of  al- 
buminous food,  and  probably  to  a  slight  extent  also  of  the 
substitution  of  the  less  complex  form  of  vegetable  albu- 
men for  that  derived  from  meat.  Now,  presuming  that 
the  vegetarian  takes  his  directions  from  official  sources, 
such  as  the  Vegetarian  Society,  and  eats,  according  to  their 
directions,  a  certain  amount  of  seed-food — i.  e.,  pease,  beans, 
lentils,  w^hole  wheat-meal,  oatmeal,  maize-meal,  etc. — per 
day,  he  will  seem,  when  he  turns  to  the  tables  of  relative 


VEGETARIANISM.  263 

food  value  of  the  various  articles,  and  compares  them  in 
quantity  and  composition  with  his  former  meat  supply,  to 
take  as  much  tissue  food  as  formerly,  or  even  a  little  more. 
This  may  be  a  fact,  as  far  as  the  mere  act  of  swallowing 
is  concerned,  but  is  by  no  means  true  of  the  amount  as  as- 
similated, of  that,  in  fact,  which  passes  into  the  blood  to 
assist  in  tissue  repair,  and  this  for  the  simple  reason  that 
in  vegetable  seeds  the  intimate  union  of  albumen  with 
starch  and  fat  and  the  hard  covering  of  such  seeds  as  es- 
cape the  teeth  or  the  cooking  process  tend  to  prevent  the 
rapid  digestion  of  albumen  in  the  stomach  which  takes 
place  in  the  case  of  meat.  As  an  indisputable  matter  of 
fact,  on  a  vegetarian  diet,  between  17  and  20  per  cent,  of 
the  albumen  is  actually  voided  with  the  faeces,  w^hile  but  a 
minute  fraction  of  animal  albumen  can  escape,  in  health, 
the  digestive  fluids  which  it  encounters.  Habit,  no  doubt, 
after  a  time,  fits  the  digestive  faculties  more  completely 
to  the  consumption  of  such  seeds,  and  indeed  we  know  that 
in  the  horse  and  the  cow  a  very  active  digestion  even  of 
starch  proceeds  in  the  stomach  ;  but  while  habit  is  gradual- 
ly doing  its  work,  the  body  will  run  some  risk  of  terminat- 
ing its  career — before  the  grass  grows  the  horse  may  starve. 

In  the  light  of  this  undeniable  fact — a  fact  which  has 
its  useful  side — tliat  vegetable  albumen  is,  weight  for 
weight,  greatly  inferior  to  meat  in  its  power  of  entering 
the  blood-current,  and  is  therefore  in  considerable  quan- 
tity rejected  by  the  bowel,  is  explained  the  extraordinary 
power  of  a  rigidly  vegetarian  dietetic  system  over  gout, 
rheumatism,  dyspepsia,  Bright's  disease,  and  some  forms 
of  epilepsy. 

If  you  reduce  very  considerably  the  amount  of  albumen 
calling  for  digestion,  you  relieve  of  course  immensely  the 
organs  whose  duty  it  is  to  digest  albumen,  and  of  those 
organs  the  liver  is  the  first.     You  also  lessen,  or  remove 


264  DISEASES    DUE    TO    UNSUITABLE    FOOD. 

entirely,  the  products  of  mal-digestion  in  that  organ,  the 
direct  and  undeniable  cause  of  gout,  rheumatism,  and  of 
biliousness,  gall-stone,  and  of  many  of  the  more  trouble- 
some secondary,  and  more  remote,  consequences  of  dys- 
pepsia, of  some  forms  of  epilepsy  and  other  nerve  disturb- 
ances, and  even  the  indirect  cause  of  Bright's  disease. 

A  peculiarity,  and  sometimes  a  very  useful  one,  of  the 
■vegetarian  dietary  is  thus  a  frequent  action  of  the  bowels 
by  reason  of  the  unassimilability  of  much  of  the  food  con- 
sumed, and  which,  while  not  indigestible  in  the  sense  of  un- 
dergoing fermentation  and  inducing  pain,  is  nevertheless, 
as  we  have  seen,  indigestible  in  the  simple  sense  that  it 
largely  escapes  the  action  of  the  gastric  and  intestinal 
fluids  unsuited  to  such  a  combination.  To  this  aperient 
action,  to  this  cure  of  constipation,  often  accompanied  as 
it  is  by  flatulence,  colic,  and  the  absorption  into  the  blood 
of  the  products  of  fermentation  lying  for  long  in  the 
bowel — all  of  which  are  but  too  often  traceable  to  a  diet 
consisting  largely  of  concentrated  foods,  foods  deficient  in 
w^aste  material,  useful  as  an  intestinal  stimulant  to  action 
— may,  alone,  be  traced  many  of  the  smaller  cures  effect- 
ed by  the  vegetarian  regimen. 

It  might  appear  difiicult  to  account  on  physiological 
grounds  for  the  fact  that,  as  the  bodily  strength  de- 
creases, and  provided  that  the  brain  be  not  itself  the  scat 
of  degeneration  or  disease,  as  in  old  age  and  insanity,  nor 
its  blood-supply  poisoned  as  in  fevers,  an  extraordinary 
condition  of  mental  calm,  not  unmixed  often  with  a 
strong  religious  bias,  should  take  possession  of  the  seat 
of  thought.  This  serene  and  even  temper  of  the  mind 
may  be  partly,  and  is  more  probably  wholly,  due  to  the 
subsidence  of  the  passions,  which  may  be  regarded  as 
ebullitions  of  nerve  force,  the  result  of  over-stimulation, 
the  source  of  which  is  often  to  be  found  in  excess  of  food. 


VEGETARIANISM.  265 

especially  of  meat,  which  possesses  more  than  one  highly 
stimulating  ingredient.  We  are  familiar  with  the  mental 
exaltation  which  ensues  on  a  full  meat  meal,  or  on  the 
consumption  of  a  small  amount  of  alcohol,  and  which  may 
either  take  a  general  form,  that  of  a  sense  of  well-being, 
or,  according  to  circumstances,  and  to  the  constitution  of 
the  individual,  be  directed  into  special  channels  and  con- 
centrated on  special  objects. 

Cut  off  the  excess  or  substitute  an  actual  deficit,  and 
such  sensations  diminish  or  vanish,  and  the  individual,  in 
place  of  feeling  that  distinct  sense  of  stimulation,  not  un- 
frequently  followed  by  torpor,  to  which  he  has  been  ac- 
customed after  each  full  meal,  and  which  has  possibly  ham- 
pered considerably  any  mental  work  in  which  he  has  been 
engaged,  experiences  but  a  slight  and  merely  comforting 
and  satisfied  sensation  which  in  no  way  debars  him  from 
mental  or  physical  work.  We  have  a  familiar  example  of 
the  subdued  frame  of  mind,  the  consequence  and  the  sign 
of  defective  or  of  a  barely  sufficing  nutrition,  in  tubercu- 
lar children.  These  fragile  mortals,  whom  it  is  difficult 
to  feed,  and  almost  impossible  to  fatten,  do  not  exhibit 
the  rough,  daring,  turbulent  spirit  which  should  and  does 
characterize  robust  child-life,  but  are  timid,  quiet,  obedi- 
ent, attentive,  and  often  pious,  a  delight  and  pride  to  their 
friends,  though  the  old  nurse,  who  has  seen  so  many  of 
this  kind  withef  and  die,  will  shake  her  head  and  express 
the  oj^inion  that  such  children  are  too  good  to  live.  As  a 
further  example  of  this  mental  condition,  I  may  cite  the 
lucid  interval  that  in  many  diseases  precedes  death.  As 
the  heart  loses  propelling  force  the  torrent  of  blood  rush- 
ing through  the  brain,  and  which  conjured  up  a  rapidly 
moving  panorama  of  visions,  slackens,  and  a  condition  of 
mental  calm  in  which  there  is  no  fear  of  death — for  the 
hold  on  life  is  so  relaxed  that  the  strong  contrast  between 
12 


266  DISEASES    DUE    TO    UNSUITABLE    FOOD. 

life  and  death  present  in  the  mind  of  the  healthy  is  absent 
in  that  of  the  sufferer — and  no  desire  to  recover,  lasts  for 
a  while  till  it  slowly  passes  into  the  state  of  amentia  whicli 
precedes  death. 

Vegetarianism,  then,  confers  on  its  votaries  the  benefits 
of  abstinence,  all  of  which  may,  however,  be  secured  on  a 
low  meat  diet,  or  indeed  on  a  full  diet  accompanied  by  a 
course  of  purgative  medicine. 

We  are  now  in  a  position  also  to  understand  why 
purgative  drugs  have  such  an  extensive  sale  ;  they  re- 
move, by  sweeping  prematurely  from  the  bowel  much 
food  that  would  otherwise  be  absorbed,  the  myriad  evils 
of  excess.  Many  a  patient  has  assured  me  that  he  owed 
his  life  to  some  aperient  nostrum,  and  I  have  usually  been 
able  to  agree  with  him  on  the  point.  Nevertheless,  of  the 
three  courses  above  given  the  full  diet  with  free  purgation 
is  the  worst  and  most  open  to  serious  objection.  As  an 
example  of  a  low  diet  in  which  meat  enters  I  may  quote 
the  following,  from  Dr.  Lauder  Brunton's  work,  "Dis- 
orders of  Digestion,"  p.  368: 

7.30  A.  M. — 10  fluid  oz.  (I  pint)  of  hot  water. 

8  A.  M. — Breakfast :  equal  parts  weak  tea  and  milk,  a 
small  quantity  of  white  sugar,  a  slice  of  fat  bacon  with- 
out a  strip  of  lean,  bread,  and  fresh  butter. 

I  p.  M. — Milk  pudding,  rice,  sago,  tapioca,  macaroni,  or 
blanc-raange,  small  biscuits  and  butter,  10  fluid  oz,'  hot 
water. 

4  to  5  p.  M. — 10  fluid  oz.  of  hot  water. 

0  p.  M. — Dinner:  white  fish  or  fowl  (usually  boiled), 
greens,  bread,  no  potatoes,  claret  7  fluid  oz.  (about  ^  of 
imperial  pint). 

8  to  9  p.  M. — 10  fluid  oz.  of  liot  water. 

II  p.  M. — 10  fluid  oz.  of  hot  water. 

Such  a  dietary  as  the  above,  and  which  is  quoted  by 


VEGETAEIANISM.  267 

Dr.  Brunton  as  that  of  a  gouty  friend  of  his,  is  quite  as 
efficacious  as  any  vegetarian  one  in  keeping  gout  and  the 
other  disorders  mentioned  at  bay  and  in  the  production 
of  mental  serenity,  but  it  is  open  to  the  same  objection — 
that  of  possible  deficiency.  Many  as  are  the  troubles  that 
follow  excess,  a  Nemesis  advancing  at  first  with  very 
silent  step,  and  then  suddenly  taking  a  serious  form,  often 
that  of  consumption,  follows  surely  in  the  wake  of  defi- 
ciency. The  late  Dr.  Anna  Kingsford,  a  most  clever 
physician,  but  an  enthusiast  in  vegetarianism,  though  of 
exceptional  physical  strength,  paid  in  that  form  the  pen- 
alty of  asceticism  pushed  beyond  physiological  limits,  and 
I  could  furnish  from  personal  experience  many  other  ex- 
amples of  the  kind. 

From  what  I  have  said  we  may  justly  conclude  that,  as 
a  not  disagreeable  means  of  affecting  a  considerable  re- 
duction in  albuminoids  where  this  is  imperative,  vegetari- 
anism may  often  be  commended,  though  the  adoption  of 
such  a  rigid  system  should  not  be  undertaken  too  sudden- 
ly, or  indeed  at  all,  except  under  competent  medical  ad- 
vice and  supervision. 

Lastly,  I  wish  to  remind  the  reader  of  what  I  have  said 
about  the  utility  of  fat  as  an  economizer  of  the  albumi- 
noids, and  to  say  that  a  vegetarian  dietary,  in  which  animal 
and  vegetable  fats  enter  freely^  is  a  very  much  fuller,  and 
likely  to  be  a  very  much  more  satisfactory,  one  than  that 
from  which  all  animal  fats  except  butter  and  cream  are 
excluded;  indeed,  vegetarianism  plus  a  liberal  allowance 
of  fats  of  all  kinds  is,  in  my  experience,  by  far  the  most 
satisfactory  dietetic  regime  in  gout,  or,  indeed,  in  any  dys- 
peptic disorder. 

The  arguments  in  favor  of  vegetarianism  drawn  from 
geographical  sources  require  but  a  brief  anwser.  Man, 
when  a  strict  vegetarian,  is,  in  most  cases,  so  by  necessity, 


268  DISEASES    DUE    TO    UNSUITABLE    FOOD. 

DOt  by  choice.  Vegetarian  races  tend  to  become,  when 
circumstances  permit  of  it,  flesh-eaters,  while  flesh-eating 
ones  never  "  vert "  to  vegetarianism. 

The  testimony  of  history  is  again  in  favor  of  the  con- 
sumption of  meat.  Spite  of  the  valor,  perseverance,  in- 
telligence, and  virtue  of  races  or  of  men  who  have  be- 
come accustomed  to  a  sparse  vegetarian  dietary,  yet,  in 
the  vast  majority  of  cases  where  men  following  the  two 
systems  of  food  have  been  opposed,  victory  has  declared 
itself  in  favor  of  the  meat-eating  race. 

Even  comparative  anatomy  affords  but  a  poor  shelter 
to  the  vegetarian  advocate.  True,  the  monkeys,  those  near 
cousins,  in  a  physical  sense,  of  man,  are  generally  vege- 
tarian-feeders, but  one  of  their  varieties,  the  baboon,  is 
not.  He  will  eat  lizards  and  insects  greedily,  and  in 
South  Africa,  at  any  rate,  takes  kindly  to  young  kids  and 
even  to  sheep,  which  he  will  seize,  kill,  and  consume. 
The  argument  that,  from  a  study  of  his  teeth,  it  is  evi- 
dent that  man  was  designed  for  a  vegetarian  system  of 
feeding,  is,  in  the  light  of  the  last  thirty  years'  advance 
in  the  study  of  the  origin  of  man  and  of  his  place  in  the 
world,  truly  an  extraordinary  one.  AVe  are,  in  short,  asked 
to  believe  that,  while  every  organ  or  portion  of  an  organ 
of  everybody  has  had  to  adapt  itself  to  the  circumstances 
in  which  it  has  been  placed,  an  exception  has  been  grant- 
ed to  this  universal  law  in  favor  of  man's  dental  arma- 
ture, wliich,  unaltered  by  custom  extending  back  to  the 
dawn  of  liistory  and  even  probably  beyond  that  limit,  still 
stands  forth  as  a  solemn  protest  against  a  dietetic  error. 

Only  of  two  other  exclusive  dietetic  regimes  need  I  speak, 
and  of  them  but  briefly:  the  milk  cure  and  the  grape  cure. 

The  Milk  lieglme. — Milk  contains,  in  the  form  of  casein, 
of  milk-sugar,  of  cream,  of  salts,  and  of  water,  all  the  neces- 
sary ingredients  of  human  food,  but  not  in  the  proportions 


THE    MILK    REGIME.  269 

iisnally  demanded  by  the  body.  Nevertheless,  certam  peo- 
ples are  said  to  thrive  vrell  on  an  exclusively  milk  diet.  This 
statement  can,  however,  only  be  accepted  with  some  quali- 
fications. The  herdsmen  of  tha  Alps  add  cheese  and  bread 
to  their  milk  dietary,  and  the  Piedmontese  maize  in  the 
form  of  polenta,  which  substances  contain  much  albumen 
and  make  up  for  the  deficiencies  of  milk  in  this  and  other 
respects. 

The  peculiarities  of  milk  that  need  to  be  noted  are  the 
following:  Its  albuminoid,  casein,  coagulates  in  the  stom- 
ach, and  this  coagulum  undergoes,  generally,  a  remarkably 
easy  digestion  by  the  gastric  juice.  The  separated  cream, 
which  consists  of  pure  fat,  is  also  exceedingly  easy  of  di- 
gestion, rarely,  even  when  present  in  considerable  quan- 
tities, undergoing  the  rancid  fermentation.  The  whey, 
which  consists  of  water  holding  in  solution  the  salts  and 
nearly  all  the  milk-sugar,  is  very  readily  absorbed.  Milk 
would  therefore  seem  to  present  us  with  an  article  of  food 
quite  of  exceptional  value  both  as  to  its  composition, 
which  includes  all  necessary  forms  of  food,  and  as  to  the 
relative  digestibility  of  these  forms.  Nevertheless,  there 
are  not  a  few  with  whom  cow's  milk,  by  reason  of  the 
coagulation  of  the  casein,  disagrees. 

Many  devices  have  been  recommended  to  overcome  the 
formation  of  a  large  and  hard  milk  curd  in  the  stomach. 
Barley  water,  rice  water,  soda  and  other  alkaline  waters, 
biscuit  powder,  sugar-candy,  and  other  substances  innu- 
merable, have  been  suggested  to  this  end  as  additions  to 
the  milk.  Uffelman  ("Archives  de  Physiologie,"  vol.  iv.) 
has  made  a  special  study  of  all  the  processes  recommend- 
ed, and  concludes  that  none  of  them  are  of  any  real  use, 
and  that,  on  the  whole,  it  is  better  to  forego  a  milk  diet- 
ary in  the  cases  when  pain  is  found  to  be  a  rapid  conse- 
quent of  its  consumption. 


270  DISEASES    DUE    TO    UNSUITABLE    FOOD. 

An  exclusively  milk  regime  is  often  useful  in  the  fol- 
lowing disorders: 

Ulcer  of  the  stomach. 

Acute  exacerbations  in  Bright's  disease. 

Gouty  stone  or  gravel. 

Prolonged  febrile  states. 

The  daily  amount  will  vary  with  the  disorder  and  with 
the  amount  of  movement  allowed  to  the  patient.  If  the 
sufferer  be  confined  to  bed,  from  3  to  5  pints  of  un- 
skimmed milk  will  suffice,  whereas  if  there  be  an  absence 
of  fever  and  exercise  be  permitted,  from  7  to  8  pints  must  be 
consumed.  Half  of  this  latter  quantity  should  be  skimmed, 
for  if  this  precaution  be  not  taken,  an  excess  of  fat,  in 
the  form  of  cream,  will  be  consumed.  In  fever,  when  the 
smaller  amounts  only  are  taken,  skimming  is  unadvisable. 

The  following  precautions  to  people  undertaking  the 
milk  cure  are  necessary. 

The  milk  allowance  for  the  day  should  be  divided  into 
four  parts,  and  each  part  should  be  taken  at  intervals  of 
four  hours,  commencing  from  8  a.  m. 

It  should  not  be  taken  very  cold,  but  should,  if  neces- 
sary, be  slightly  warmed  before  it  is  consumed. 

If  constipation  results,  three  cups  or  more  of  black  cof- 
fee may  be  allowed  each  day.  If  diarrhosa  ensues,  and  if 
the  cause  be  not  found  in  a  milk  too  rich  in  cream,  a  small 
quantity  of  raw-meat  essence,  directions  for  the  making 
of  which  are  to  be  found  in  every  modern  invalid  cook- 
ery-book, must  be  swallowed  each  time  before  the  milk  is 
taken. 

A  diet  exclusively  of  milk  must  in  no  case  be  contin- 
ued for  more  than  six  or  eight  weeks,  but  should  then  be 
supplemented  by  other  light  foods. 

Besides  its  utility  in  an  exclusive  dietary,  milk  possess- 
es, as  we  all  know,  a  prominent  place  in  almost  every 


MILK   AND   ITS   DERIVATIVES.  271 

food  system,  and  even  vegetarianism  has  had,  at  a  sacrifice 
to  consistency,  to  retain  this  very  decidedly  animal  fluid. 

As  derivatives  of  milk  I  may  mention  the  following: 

Whey,  rich  in  salts,  has  slight  nutritive  properties,  and 
forms  an  agreeable  drink  in  febrile  states. 

Butterndlk,  a  by-product  in  the  manufacture  of  butter, 
is,  spite  of  its  sourness,  easily  tolerated  by  the  stomach 
and  possesses  marked  nutritive  qualities.  It  forms  an  ex- 
cellent, and  often  advantageously  for  some  days  an  exclu- 
sive, food  in  severe  gastric  catarrh. 

Pexjtonized  and  pancreatized  milk  may  be  prepared  by 
the  use  of  the  peptonizing  powders  sold  at  all  large  chem- 
ists. The  process  is  simple,  full  directions  accompanying 
the  powders.  Pancreatized  milk  is  equal  to  the  pepton- 
ized in  digestibility  and  is  much  more  agreeable. 

JTowniss  is  the  fermented  milk  of  the  cow  or  the  mare. 
This  preparation,  as  well  as  kephir  and  galactase,  also  fer- 
mented milks,  is  of  considerable  use  in  all  forms  of  gas- 
tric, and  in  many  of  intestinal,  derangement.  It  contains, 
of  course,  a  small  proportion  of  alcohol  (2.5  per  cent.). 

The  Grcqje  Hegime. — This  scarcely  demands  serious  no- 
tice at  our  hands.  An  analysis  of  the  grape  shows  that, 
as  an  exclusive  article  of  dietary,  it  cannot  possibly  for 
long  meet  the  bodily  needs,  since  the  relative  quantity  of 
grape-sugar  present  ranges  from  10  to  15  per  cent.,  while 
that  of  soluble  albuminoids  is  often  as  low  as  0.6  per  cent., 
and  never  rises  to  1  per  cent.  As  an  adjunct  to  other 
foods,  grapes  consumed  to  the  extent  of  4  to  6  lbs.  a  day 
are  useful  in  certain  cases  of  constipation  and  of  func- 
tional kidney  failure,  for  they  promote  markedly  the  ac- 
tivity both  of  the  bowel  and  of  the  kidney. 

We  have  now  come  to  the  end  of  our  study  of  one  im- 
portant cause  of  bodily  disturbance — a  defective  food  sup- 


272  DISEASES   DUE    TO    UNSUITABLE   FOOD. 

ply — and  we  have  viewed  the  subject  in  the  three  natural 
divisions  to  which  it  lends  itself — viz.,  defective  by  de- 
ficiency, by  excess,  or  by  unsuitability. 

So  far-reaching,  indeed,  are  the  consequences  of  errors 
in  nutriment,  telling,  as  they  do  and  must,  on  the  whole 
body,  even  to  its  most  distant  organ,  and  defiling  in  the 
food  supply  the  very  sources  of  all  life,  growth,  mainte- 
nance, and  movement,  that  it  is  no  unusual  ex^jerience  to 
encounter  able  men  who  see  in  food  reform  the  physical, 
mental,  and  moral  regeneration  of  mankind.  But  even  if 
mankind  were  willing  to  concede  to  a  physiological  diet 
scale  its  claim  to  be  "the  one  thing  needful,"  the  physician 
would  find  himself  often  in  sore  straits  when  asked  to  pre- 
scribe to  each  man  his  proper  dietary,  and  the  amount  of 
necessary  failure  would  soon  discredit  the  w^hole  scheme. 
Man  is,  unfortunately  for  the  dietetist,  a  varying  quan- 
tity, not  only  as  regards  himself,  but  in  relation  to  all 
other  men — the  food  of  to-day  is  the  poison  of  to-morrow, 
nay,  the  food  of  breakfast  is  often  the  poison  of  dinner. 
"  My  dear  sir,"  the  dietetist  will  say,  "  all  difiiculties  of 
digestion  would  disappear  in  a  few  years  under  our  sys- 
tem." Unfortunately,  unless  the  whole  system  of  life  was 
simultaneously  altered,  dyspepsia  would  not  disaj^pear. 
Grief  and  sorrow  and  worry  and  anxiety,  the  most  potent 
of  all  disturbers  of  the  digestive  organs,  will,  like  the  poor, 
be  with  man  till  the  days  of  the  millennium.  There  is  a 
great  deal  of  good,  much  more  than  is  recognized  by  mod- 
ern medical  science,  in  a  wise  dietary,  but  could  we  even  in 
every  case  overcome  the  diflSiculties  in  prescribing  for 
each  meal  of  each  day,  its  kind  and  its  limit,  we  should 
even  then  find  that  disease,  vice,  and  mental  failure  had 
not  departed  from  the  land. 

We  are  now  called  on  to  consider  the  various  disorders 
that  may  occur  in  the  digestive  process. 


CHAPTEK  X. 

DISEASES  DUE   TO  IMPERFECT   DIGESTION. 


Regions  icliere 
Digestion 
takes  place. 


(a)  Mouth.     < 


(d)  Liver 
(secondary 
digestion). 


{e)  Tissues 

(tertiary 

digestion). 

12* 


(h)  Stomach.   < 


(c)  Intestines.  ■< 


Effects  of  Faihire  of  Digestion. 

In  tliu  mouth  there  are,  practically,  no  signs  of 
primary  failure.  It  reflects,  however,  owing  to 
its  intimate  nerve  connections,  the  derange- 
ments of  the  stomach. 

Thus  in  atony  of  the  stomach,  the  mouth  is  clean 
but  pale,  and  the  tongue  usually  clear,  but  in 
inflammatory  derangements  of  the  organ  the 
mouth  is  foul  and  congested,  the  tongue  thick- 
ly furred  and  the  taste  greatly  vitiated. 
r  (1)  Weakness  of  stomach=atonic  dyspepsia,  a  por- 
tion of  general  muscular  or  nervous  debility. 

(2)  Inflammatory  disorder  of  stomach  =r  acute  or 
chronic  gastric  catarrh,  the  result  of  over- 
stimulation of  the  organ,  but  sometimes  due 
to  acute  gout. 

(3)  Degenerative  disease  of  stomach—e.  g.,  cancer 
or  ulcer.     Very  rare . 

(1)  Weakness  of  intestine,  a  portion  of  general 
want  of  tone  in  the  body. 

(2)  Inflammatory  disorders,  due  to  irritation. 

(3)  Degenerative  disease  —  e.g.,  cancer,  ulceration, 
etc. 

Degenerative, 
Cirrhosis  of  the  liver. 
Waxy  degeneration  of  the  liver. 
Fatty  degeneration  of  the  liver. 
Cancerous  degeneration  of  the 

liver. 
Acute   yellow   atrophy  of  the 

liver,  etc. 


(of 


Functional. 
Gout. 

Biliousness. 
Gall  stone. 
Glucosuria 

one  kind). 
Albuminuria  Cof 

one  form). 
Obesity. 
Rheumatism. 

Probably  many  other  ailments  but  little  traced  out, 
as  yet. 


Treatment. 

Of  atony  of  stomach  and  intestines.    Improve  general  health. 

Of  inflammatory  derangements  of  stomach  and  intestines.  Eemove 
all  sources  of  irritation,  soothe  the  organs,  giving  the  simplest 
and  lightest  foods.     Improve  general  health. 

Of  degenerative  diseases  of  stomach  and  intestines.  Soothe,  and 
seek,  with  extreme  caution,  to  nourish. 

Of  the  five  functional  disorders  of  the  liver.  Improve  general 
health.  Simplify  to  the  uttermost  the  dietary.  Plenty  of  ex- 
ercise and  of  fresh  air. 

Of  obesity  and  of  rheumatism  the  treatment  must  be  very  specially 
adapted  to  each  case,  but  exercise,  simple  dietary,  a  dry  climate, 
and  suitable  clothing,  will,  in  all  cases,  effect  much  good. 


Ube    fOO^    system— {conti9iued). 


CHAPTER  X. 

DISEASES  DUE  TO  IMPERFECT  DIGESTION. 

Let  us  epitomize  tlie  digestive  processes. 

The  ciUmentarT/  canal,  by  which  is  understood  that  tube 
of  varying  calibre  which  extends  from  the  mouth  to  the 
termination  of  the  bowel,  is  the  seat  of  the  first  rough  as- 
sortment of  food,  which  I  GdXl  primary  digestion. 

This  first  process  of  digestion  is  an  exceedingly  simple 
one.  The  food  excites  the  various  parts  of  the  canal,  with 
which  it  comes  in  contact,  to  excrete  —  i.  e.,  pour  out — 
fluids,  which  have  the  power  of  compelling  each  molecule 
of  the  food  upon  which  they  can  act  to  take  up  an  extra 
molecule  of  water,  this  sufficing  to  convert  the  insoluble 
colloids,  fat,  albumen,  and  starch  into  soluble  crystalloid 
forms,  which  are  capable  of  passing  through  the  walls  of 
the  stomach  and  intestine,  or  of  being  what  is  called  ab- 
sorbed, simply  because  they  are  endowed  with  a  property 
common  to  all  crystalloids,  a  power  to  pass  through  ani- 
mal membranes. 

The  various  digestive  fluids  are  prepared,  by  special 
glands  in  the  mouth,  stomach,  and  intestine,  from  the 
blood  circulating  around  them,  each  fluid  containing  one  or 
more  special  constituents  or  ferments,  by  means  of  which 
it  effects  the  metamorphosis  of  colloids  into  crystalloids. 


276  DISEASES    DUE    TO    liirERFECT    DIGESTION. 

In  the  mouth  the  ferment  (ptyalin)  in  the  saliva  digests 
starch  only. 

In  the  stomach  the  ferment  (pepsin)  in  the  gastric  juice 
has  power  only  over  albumen. 

In  the  hoicel  are  poured  out  three  ferments  prej^ared  by 
the  pancreas  (amylopsin,  trj'psin,  and  steapsin),  which  di- 
gest all  three  articles  of  food,  starch,  fat,  and  albumen. 
Bile  emulsionizes  fat.  Finallj^,  the  smaller  intestinal 
glands  pour  out  an  admixture  of  digestive  fluids  similar 
to  those  of  the  pancreas. 

It  is  thus  evident  that  such  foods  as  escape  digestion  in 
the  mouth  and  stomach  may  be  converted  into  crystalloids 
in  the  bowel,  and  thus  be  utilized  as  nutriments. 

The  whole  of  the  alimentary  canal  secretes  the  lubri- 
cator, mucus. 

Spite  of  the  gauntlet  which  all  food  must  thus  run  in 
its  passage  through  the  body,  much  material,  from  one 
cause  or  another,  escapes  the  digestive  processes.  This 
so-called  waste  itself  plays  an  important  role  in  the  econ- 
oni}^,  for  it  stimulates  the  bowel  wall  and  keeps  it  in  con- 
stant movement,  preventing  thus  undue  accumulations  of 
material  in  any  part  of  the  course,  presenting  each  part 
of  the  contents  equally  to  the  digestive  fluids,  and  finally 
expelling  the  undigested  residue  from  the  body. 

It  must  also  be  understood  that  the  muscles  of  the  mouth 
which  move  the  jaws  and  which  push  the  food  between 
the  teeth,  for  the  tongue  is  only  a  double  muscle  worked 
by  muscles,  and  those  that,  set  in  the  walls  of  the  stomach 
and  intestine,  first  rotate  and  then  push  onwards  the  con- 
tents of  those  organs,  play  a  very  important  part  in  the 
digestive  process,  and  one  which,  if  deranged,  will,  in  the 
face  of  the  most  perfect  sujiply  of  digestive  fluid,  com- 
pletely upset  the  digestive  procedures. 

Such  is  primary  digestion. 


SECONDARY    IMGESTION.  277 

Secondary  digestion  takes  up  the  food  at  its  moment  of 
absorption,  and  carries  it  through  the  liver  into  the  gen- 
eral circulation. 

Fat,  as  we  know,  does  not  pass  through  this  organ  at  all, 
but  through  the  abdominal  lymphatic  ducts  and  glands, 
undergoing  therein  some  probable,  but  unknown,  change, 
and  issuing  thence  into  the  general  circulation. 

The  foods  going  to  the  liver  are,  therefore,  now  repre- 
sented by  grape-sugar  and  by  soluble  albumen,  which  lose 
somewhere — probably  in  their  ^jassage  through  the  intes- 
tinal w^all — that  extra  molecule  of  water  by  virtue  of 
which  they  became  crystalloids,  and,  carried  swiftly  by  the 
portal  vein  to  the  liver,  encounter  therein,  in  the  guise  of 
cells,  new  animal  membranes  Avhich  speedily  arrest  their 
onward  course. 

We  have  thus  grape-sugar,  now  called  glycogen  or  ani- 
mal starch,  and  albumen,  both  as  colloids,  lodged  in  the 
liver.  What  shall  frank  them  through  this  gate  placed  at 
the  entry  of  the  general  blood-stream  ? 

The  arterial  blood  in  the  hepatic  artery.  We  know 
that  the  liver  is  the  only  bodily  organ  with  two  blood 
supplies.  One,  a  large  one,  the  portal  vein  bringing  food; 
the  other,  a  small  one,  the  hepatic  artery  bringing  arterial 
blood  to  nourish  the  organ.  ISTow,  all  arterial  blood  con- 
tains two  ferments,  which  have  the  powers  respectively  to 
convert  starch  to  grape-sugar,  and  insoluble  to  soluble 
albumen. 

Thus,  while  intermittently — i.  e.,  after  each  meal — the 
portal  vein  brings  to  the  liver  large  fresh  supplies  of  in- 
soluble glycogen  and  albumen,  the  hepatic  artery,  con- 
stantly, but  in  small  amounts,  brings  blood  that  can  di- 
gest once  more  to  grape-sugar  and  soluble  albumen  those 
materials. 

By  this  simple  but  perfect  plan,  while  food  need  only 


278  DISEASES    DUE    TO    IMPERFECT   DIGESTION. 

be  taken  at  intervals,  the  blood-stream  of  the  body  is  con- 
stantly siip[)lied  Avith  the  small  quantities  of  fuel  (grape- 
sugar)  and  tissue-repair  material  (soluble  albumen  or  blood 
plasma)  which  it  needs  to  keep  life  going  in  an  even  and 
systematic  manner. 

Not  all  the  albumen,  however,  passes  on  thus;  some  is 
burned  in  the  liver  into  urea,  and  some  is  converted  to  bile 
acids. 

Tertiary  digestion  takes  up  the  running  where  the  sec- 
ondary process  leaves  it,  and  concerns  itself  with  the  final 
destiny  of  the  grape-sugar  and  the  soluble  albumen  in  the 
blood-stream. 

Tlie  grape-sugar,  and  the  fat  which  it  now  meets  again 
in  the  general  blood-stream,  are  carried  off  to  the  body 
cells,  and  there  are  burned  by  the  aid  of  the  oxygen  drawn 
in  by  the  lungs;  the  albumen,  travelling  to  the  same  des- 
tiny, undergoes  a  partial  oxidation  there,  supplying,  in 
addition,  each  cell  with  material  with  which  to  interact. 

Now  let  us  turn  to  the  derangements  of  this  triple 
process. 

I.  DISORDERS    OF    PRIMARY   DIGESTION— 

i.  e.,  of  those  occurring  in  the  alimentary  canal. 

For  purposes  of  study,  and  because  such  division  is 
founded  on  physiological  grounds,  the  alimentary  canal 
may  be  viewed  as  consisting  of  two  parts;  the  first  in- 
cluding the  mouth  and  the  stomach,  the  second  only  the 
intestine. 

Derangements  of  Mouth  and  Stomach. 

The  connection  between  these  two  organs,  spite  of  the 
space  separating  them  and  their  distinct  digestive  func- 
tions, is  a  very  close  one,  so  intimate  indeed  that  the  one 
organ  may  be  justly  viewed  as  a  direct  continuation  of 


DISORDERS    OF    PRIMARY    DIGESTION.  2*79 

the  other.  Of  the  two,  the  stomach  plays  the  leading 
part,  calling  the  tune,  so  to  speak,  in  all  derangement; 
the  mouth  obediently  following,  and  reflecting  on  its  sur- 
face the  gastric  states.  This  perfect  interaction,  I  need 
scarcely  say,  is  brought  about  by  means  of  the  nervous 
system. 

^e  will,  therefore,  discuss  indigestion  as  seen  in  the 
stomach,  referring,  when  necessary,  to  the  secondary 
states  thereby  induced  in  the  mouth. 

The  stomach  functions  may  become  deranged,  like  those 
of  every  other  organ  in  the  body,  as  a  result  of  weakness, 
inflammation,  or  degeneration. 

(«)  Gastric  Derangement,  the  result  of  Debility,  the  Atonic 
Dyspepsia  of  the  text-books. 

This  is  not  a  disease  at  all,  nor  is  it  a  localized  state, 
but  springs  from  a  general  debility  of  the  muscular  and 
nervous  systems  common  to  the  whole  body. 

Not  the  stomach  or  mouth  alone,  but  the  whole  alimen- 
tary canal,  share,  therefore,  in  the  debility.  ISTow,  w^e  know 
that  the  mouth,  stomach,  and  intestine  are  all  provided 
with  muscles  which  by  their  contraction  distinctly  aid  the 
digestive  process,  and  since  the  food  excites  the  stomach 
and  intestine  to  muscular  action  and  to  secretion,  and  can 
do  so  only  by  the  agency  of  the  reflex  nerves,  it  is  clear 
that  where  we  have  a  state  of  muscular  and  nervous  fail- 
ure, we  must,  at  the  same  time,  also  have  marked  digestive 
incapacity. 

The  sufferers  from  atonic  dyspepsia  are,  then,  the  aged 
and  the  feeble. 

TJie  symptoyns  are:  defective  digestion;  undue  retention, 
and  consequent /ermen^a^zo;z  of  food  in  the  stomach  and 
intestine;  pain  from  the  development  of  gas  (wind),  and 
the  distension  with  it  of  the  flabby,  non-resisting  stomach 
and  intestinal  coils;  constipation,  alternating  with  diar- 


280  DISEASES    DUE    TO    IMPERFECT    DIGESTION. 

rhoea^  the  latter  set  up  by  the  irritating  products  of  fer- 
mentation. 

The  line  of  treatment  is  plain.  The  food,  in  the  first 
place,  must  be  cut  down  to  the  low  level  of  the  digestive 
capacity;  must  consist  of  material  not  apt  to  undergo 
rapid  fermentation;  and  must,  in  addition,  contain  plenty 
of  w^aste  to  stimulate  the  stomach  and  intestine  to  action. 
Fruit,  milk,  porridges,  brown  bread,  vegetables  (except 
potatoes),  fish,  oj^sters,  game,  chicken,  and  w^ell-kept  mut- 
ton are  the  most  suitable  articles,  but  must  be  taken  in 
small  quantities.  Natural  white  wines,  cider,  light  beer, 
cofiee,  and  decoction  of  cocoa -nibs  are  the  best  bever- 
ages. 

In  the  second  place,  the  ichole  muscular  and  nervous  tone 
of  the  body  must  be  improved  ;  and  as  this  end  is  grad- 
ually secured,  the  amount  of  daily  food  may  be  corre- 
spondingly increased,  both  in  amount  and  variety.  Mas- 
sage, by  its  system  of  passive  exercise,  combined  with 
forced  feeding,  can  cure  many  sufferers  from  atonic  dys- 
pepsia ;  but  my  experience  of  some  into  whose  hands  this 
simple  method  of  cure  has  often  fallen  would  lead  me  to 
be  exceedingly  chary  of  recommending  it.  In  any  case, 
massage  is  an  artificial  as  well  as  an  expensive  means  of 
cure,  and  can,  therefore,  but  in  exceptional  cases,  be  had 
recourse  to. 

The  restoration  of  muscular  and  nervous  tone  in  cases 
where  such  restoration  is  possible,  w^hich  it  manifestly  is 
not  in  the  very  aged,  must  be  resolutely  undertaken.  All 
fears  of  evil  consequences  from  exercise,  etc.,  must  be 
resolutely  discarded,  and  this  is  a  necessary  w^ord  of  ad- 
vice, for,  particularly  in  the  female  sex,  there  exist  cer- 
tain misplacements  upon  which  great  stress  is  laid,  and  for 
the  relief  of  which  rest  is  often  recommended,  when,  in 
reality,  the  vast  majority  of  these  disorders  is  due  simply 


TREATMENT    OF    ATONIC    DYSPEPSIA.  281 

to  lack  of  tone,  and  can  be  cured  only  by  a  gradual  eleva- 
tion of  health  and  improvement  of  muscular  tone.  Three 
things  have  damaged  the  female  constitution  :  defective 
muscular  exercise  and  feeding  in  youth,  the  nature  of  the 
clothing  worn,  and  the  attentions  of  the  gynaecologist.  An 
excellent  and  most  sensible  book,  entitled  "Health,  Beauty, 
and  the  Toilet,"  by  the  late  Dr.  Anna  Kingsford,  gives,  bet- 
ter than  I  can,  all  necessary  directions  for  a  rational,  light, 
muscle-freeing  style  of  female  apparel,  which  delicate  ladies 
cannot  do  better  than  to  carry  out. 

Whatever  the  sex  of  the  sufferer  from  atonic  dyspepsia, 
the  first  step  should  be  to  consult  a  skilled  and  unpreju- 
diced medical  man,  who  is  likely  to  give  the  case  a  patient 
and  impartial  hearing.  By  such  a  plan,  every  allowance 
will  be  made  for  the  sj^ecial  conditions  present.  It  is  worse 
than  useless  to  pin  one's  faith  to  one  nostrum,  dietetic  or 
other.  Vegetarianism  is  often,  for  example,  an  excellent 
fcod  system  in  these  cases  ;  but  many  precautions  are 
necessary  for  those,  especially  if  feeble,  who  undertake  it. 

The  removal  of  all  deleterious  habits,  the  infusion  into 
life  of  a  something  to  vary  monotony  and  to  stimulate 
to  exertion  of  the  mind,  physical  exercise,  graded  to  the 
strength  of  the  individual — all  these  are  necessary,  and,  in 
conjunction  with  a  sufficient  but  wisely  selected  dietary, 
cannot,  in  the  vast  majority  of  cases,  fail  to  effect  a  cure. 

The  great  bar  to  success  is  often  a  strange  mental  torj^or 
or  a  morbid  irritability,  oj^ponents  to  be  defeated  not  by 
the  sheer  force  of  will  in  the  medical  adviser,  but  rather  by 
circumvention  and  tact,  A  man  may  be  as  easily  tempted 
by  sufficient  inducement  to  a  wholesome  as  to  an  unwhole- 
some life.  Hygiene  may  take  a  leaf  from  the  tempter  of 
man.  It  also  may  show  the  sufferer  figuratively  the  king- 
doms of  the  world,  and  add,  "All  these  things  will  I  give, 
if  you  will  fall  down  and  worship  me." 


282  DISEASES    DUE    TO    IMPERFECT   DIGESTION. 

We  may  fittingly  conclude  this  subject  with  a  colloquy 
between  the  eminent  physician,  Sir  W.  Clarke,  and  a  lady 
patient.  "  The  old-fashioned  way  of  working,  rather  with 
our  own  iiands  than  by  proxy,"  said  the  doctor,  "is  the 
best  of  tonics ;  put  on  brown  holland  aprons  and  help  in 
the  house  two  or  three  hours  a  day."  "  But  that  is  not  the 
fashion,"  replied  the  mother.  "Xo  fault  of  mine,"  said 
the  doctor,  "  you  cannot  cheat  Nature  ;  man  is  a  machine 
made  for  motion,  not  for  idleness  ;  what  you  disdain  with 
your  hands  falls  on  your  nerves  ;  if  you  refuse  Nature^s 
tonics,  you  must  take  mine — a  very  poor  substitute,  I  can 
assure  you." 

This  class  of  patients  will  often  request  jihysic  ;  it  is  in 
keeping  Avith  the  state  of  their  minds  to  choose  the  less 
laborious  course,  and  medicine  seems  to  offer  a  royal  road 
to  health.  This,  of  course,  is  a  delusion.  Those  slow  stim- 
lants,  euphemistically  called  tonics,  are  the  usurers  of  Nat- 
ure. If  they  make  an  advance,  it  is  but  for  a  brief  period 
and  at  ruinous  rates.  An  elixir  of  life — for  such  a  real 
tonic  would  be — is  as  great  a  physical  absurdity,  as  idle 
a  dream,  as  the  philosopher's  stone. 

To  administer  any  form  of  physic  in  atony  of  the  ali- 
mentary track  is,  then,  a  mistake.  It  does  no  good,  and 
distracts  often  the  patient's  attention  from  the  one  thing 
needful — an  altered  mode  of  life.  At  the  outside,  an  occa- 
sional and  mild  purgative  to  clear  out  fermenting  foods  is 
all  that  should  be  attempted. 

The  state  of  the  tongue  in  atonic  digestion  is  clean,  or 
nearly  so  ;  the  gums  are  generally  sound,  often  pale,  the 
preservation  of  the  teeth  fair.  The  throat  is  pallid  and 
generally  relaxed,  the  uvula  often  dependent. 

(b)  Gastric  Derangement  the  result  of  Inflammation. — 
This  class  of  derangement  offers  a  strong  contrast  to  the 
one  just  discussed.     That  was  not  a  disease  and  was  gen- 


ACUTE  GASTRIC  CATAERH.  283 

eral  ;  this  is  a  decided  disease,  and  is  as  nearly  local  as  a 
disease  can  be. 

Atonic  digestion  was  a  mere  state  in  perfect  harmony 
vnth  the  re^t  of  the  hoihj,  and  only  comes  to  be  regarded  as 
a  local  disorder  because  the  patient  fails  to  take  in  the 
whole  situation.  In  inflammatory  disorder  we  have,  as 
cause,  a  localized  over-stimulation,  leading,  in  the  first  in- 
stance, to  local  excitation,  and  ending,  if  the  pernicious 
cause  be  maintained  in  action,  in  hopeless  bankruptcy  of 
the  part. 

All  inflammatory  processes  may  be  either  acute  or 
clironic.  We  must  therefore  deal  with  our  subject  un- 
der the  two  divisions  of  acute  and  chronic  gastric  inflam- 
rnatory  disorder^  using,  for  the  sake  of  brevity,  and  to 
avoid  confusion  in  the  mind  of  the  reader,  the  usual  terms 
Acute  and  Clironic  Gastric  Catarrh. 

The  Acute  Form  of  Gastric  Catarrh. 

Its  causes  are  to  be  sought  in  excessive  stimulation  of 
the  stomach,  and  this  may  be  brought  about  by  one  of 
three  causes.  The  first  and  most  common  is  alcoholic  ex- 
cess ;  the  next  in  frequency,  irritation  of  the  surface  of  the 
stomach,  the  result  of  some  irritant  poison  in  the  blood, 
usually  gout  poison,  but  other  poisons,  notably  fever  poi- 
sons, have  a  like  effect ;  the  least  common  cause  of  all  is 
an  habitual  excess  in  food. 

The  heavy  drinker  is  the  common  subject  of  this  dis- 
order. His  so-called  biliousness  is  simply  gastric  catarrh, 
the  sour  mucus  ejected  being  mistaken  for  bile.  The  at- 
tack follows,  and  is  clearly  traceable  to  a  recent  debauch. 
If  gout  be  the  cause,  the  attack  is,  to  some  extent,  peri- 
odic, and  takes  the  place  of  inflammation  of  the  joint  of 
the  big  toe  or  other  part.  In  these  cases  the  attack  is 
excited,  not  caused,  by  some  very  trifling  dietetic  excess. 


284  DISEASES    DUE    TO    IMPEEFECT   DIGESTION. 

As  a  consequence  of  mere  gluttony,  gastric  catarrh  is 
rare. 

The  symptoms  are  readily  recognized,  and  the  cause  of 
their  appearance  is  easily  traced.  Ordinary  stimulation  of 
the  stomach  produces  an  excretion  of  gastric  juice  and  of 
mucus  in  necessary  quantity,  and  sets  up  slow  and  regular 
muscular  contraction  in  the  organ.  Excessive  stimulation 
produces,  as  a  natural  result,  phenomena  of  the  same  class, 
but,  in  projiortion  to  the  stimulation,  excessive. 

AYe  v/itness,  then,  in  acute  gastric  catarrh,  these  local 
signs  of  derangement  :  first  of  all,  acidity  ;  secondlj^,  in- 
digestion, the  result  of  the  presence  of  large  quantities  of 
mucus,  fermented  by  the  heat  of  the  stomach,  and  which 
coats  all  swallowed  food  ;  l\\wdi\j,pain  and  vomiting,  the 
consequence  of  the  excited  muscular  sensitiveness  and  ac- 
tivity. There  is  furthermore  present  a  sensation  of  inter^ 
nal  heat,  which  tempts  the  sufferer  to  desire  cooling  fluids. 
These  symptoms  are  accompanied  by  more  or  less  of  fever. 
The  severity  and  duration  of  the  attack  varies.  Usually 
in  twenty-four  hours  the  vomiting  ceases  and  the  pain 
lessens — in  short,  the  local  inflammation  subsides.  At  the 
same  time,  the  long  list  of  secondary  daacovcdori?,,  headache, 
giddiness,  fever ishness,  despondency,  etc.,  improve,  but  gen- 
erally a  week  elapses  ere  recovery  can  be  called  perfect. 

In  acute  gastric  catarrh,  the  mouth  indicates  clearly  the 
state  of  gastric  disorder  present.  The  tongue  is  thickly 
furred,  the  gums  and  throat  are  reddened,  the  teeth  are 
coated  with  mucus,  the  breath  is  hot  andfoid. 

Acute  gastric  catarrh  is  sometimes  s2)oken  of  as  gastric 
fever,  and  though  the  term  is  a  bad  one,  inasmuch  as  it  is 
often  also  employed  to  designate  typhoid  fever,  yet  it  is 
correct  in  one  way,  as  indicating  that  this  very  common 
variety  of  stomach  derangement  is  attended  by  many  of  the 
symptoms  which  characterize  the  onset  of  specific  fevers. 


ACUTE    GASTRIC  CATARRH.  285 

The  treatment  of  acute  gastric  catarrh  is  as  follows  : 

1.  Rest  tlie  stomach.  In  bad  cases  stop  all  supplies  of 
food  for  twenty-four  hours,  allowing  during  that  space 
nothing  but  ice,  or  effervescing  alkaline  waters  in  small 
doses.  Then  commence  very  cautiously  to  feed  the  j^a- 
tient,  beginning  with  the  lightest  and  simplest  articles. 
Koumiss,  Benger's  farinaceous  food,  ISTestle's,  Ridge's,  or 
other  invalid  foods,  the  simpler  the  better,  barley  water, 
rice  water,  whey,  etc.,  or  a  meat  essence,  such  as  Brand's, 
quite  free  from  fat,  may  be  tried.  From  these,  and  such 
as  these,  must  the  selection  be  made.  In  step  with  a  sub- 
sidence of  the  attack,  an  advance  may  be  made  to  fruits, 
white  fish,  oysters,  farinaceous  puddings,  soups,  etc.,  till  an 
ordinary  diet  is  at  last  reached. 

Buttermilk,  as  a  sole  article  of  food  for  the  first  four  or 
five  days,  succeeds,  in  some  cases,  admirably. 

2.  Soothe  the  inflamed  stomach. 

To  this  end  the  organ  must  first  be  emptied  by  a  full 
draught  of  warm  water,  which  is  usually  sufiicient  to  ex- 
cite emesis.  This  course  may  be  followed  by  the  adminis- 
tration of  a  mild  purgative,  and  by  the  application  of  a 
mustard  plaster  over  the  stomach,  the  precise  region  being 
easily  discoverable  by  its  tenderness  on  pressure. 

Then,  in  trisnitrate  of  bismuth,  we  possess  an  excellent 
drug  that  combines  in  itself  all  the  great  marks  of  a  good 
medicinal  agent,  for  its  action  is  restricted  to  the  part  to 
which  it  is  applied,  and,  being  insoluble,  or  nearly  so,  in  the 
juices  of  the  body,  it  has  no  secondary  and  undesirable 
influences. 

An  ounce  of  it  may  be  bouo-ht,  and  as  much  as  will  lie 
on  a  sixpence  may  be  placed  on  the  tongue  and  washed 
down  with  a  few  raouthfuls  of  soda  water,  every  two  or 
three  hours,  till  all  nausea  and  pain  subside. 

Rest  and  quiet  are  essentials,  in  bad  cases,  to  a  speedy  cure. 


286  DISEASES    DUE    TO    IMPERFECT   DIGESTION. 

I  must  caution  the  reader  against  a  pitfall.  If  the 
sufferer  be  an  alcoholic,  he  will  probably,  during  the  at- 
tack, try  a  little  alcohol,  and  will  retain  it  at  a  time  when 
everything  else  is  vomited.  The  friends,  alarmed  at  the 
rejection  of  all  other  substance,  will  petition  that  the  alco- 
holic indulgence  be  sanctioned.  This  request  must  not  be 
granted,  or  the  attack  will  be  indefinitely  prolonged. 

The  Chronic  Form  of  Gastric  Catarrh. 

This  is  not  by  any  means,  as  we  might  conjecture,  a 
necessary  and  invariable  consequence  of  repeated  attacks 
of  the  acute  variety.  A  gouty  man,  or  one  given  to  only 
occasional  alcoholic  excess,  may  experience  in  the  course 
of  his  lifetime  many  dozens  of  even  severe  attacks  of 
acute  gastric  catarrh,  and  yet,  inasmuch  as  time  for  re- 
covery is  allowed  between  each  attack,  he  may  never  be- 
come a  sufferer  from  the  chronic  form  of  the  malady,  at 
least  not  to  a  troublesome  degree.  It  is  the  man  who  reg- 
ularly, systematically,  abuses  his  stomach,  who  is  in  the 
habit  of  keeping  himself  up  by  frequent  imbibitions  of 
alcohol,  often  taken  on  an  empty  stomach,  who  becomes 
most  surely  a  victim. 

Let  us  trace  the  genesis,  and  then  enumerate  the  symp- 
toms, of  chronic  gastric  catarrh. 

Throughout  the  body  there  is  everywhere  disposed,  for 
use  mainly  as  a  binding  material,  a  substance  called  fibrous 
tissue,  which  enters  largely  into  the  construction  of  the 
stomach  —  as  it  does  into  that  of  the  liver  and  kidneys — 
acting  as  a  support  to  the  glands,  which,  studded  all  over 
the  surface  of  the  stomach,  prepare  from  the  blood,  and 
supply  for  use  in  digesting  albuminoid  food,  the  gastric 
juice.  The  effects  of  stimulation  of  this  fibrous  material 
are  everywhere  the  same.  First,  it  swells,  and  after  this 
swelling;  has  been  maintained   for  some  time — often  for 


CHEONIC    GASTRIC    CATAEEII.  287 

years — it  begins  slowly  to  contract,  this  contraction  nec- 
essarily involving  the  strangulation  of  the  tissues  which  it 
surrounds.  There  is  no  relief  from  this  process  when  once 
it  has  become  established ;  the  advance  of  it  may  be  ren- 
dered more  slow  by  judicious  means,  but  it  cannot  be 
arrested.  It  is  the  degeneration,  the  death  approach,  of 
the  tissue,  and  is  a  normal  phenomenon  when  seen  in  the 
aged. 

The  results,  then,  of  chronic  stimulation  of  the  lining  of 
the  stomach  are  easy  to  forecast.  The  glands  become 
gradually  constricted  and  rendered  useless,  and  the  supply 
of  digestive  fluid  is  cut  off.  The  small  blood-vessels  suffer 
in  a  like  manner,  but  to  a  less  extent  ;  least  of  all,  and  last 
of  all,  are  the  mucous  glands  affected. 

The  stomach  of  a  sufferer  from  this  variety  of  disorder 
presents,  as  a  matter  of  fact,  when  viewed  after  death,  or 
during  life  by  means  of  the  endoscope,  the  following  char- 
acteristic appearance  :  The  surface  is  a  dusky  gray,  a 
result  of  the  diminished  blood  supply,  is  covered  with  a 
film  of  mucus,  usually  in  a  state  of  decomposition,  the  gas- 
tric juice  (if  food  be  present  to  excite  its  secretion,  for  an 
empty  stomach  contains  none)  is  defective  in  quantity  and 
quality.  The  muscular  power  of  the  stomach  may  be,  but 
often  is  not,  much  impaired. 

The  symptoms  complained  of  by  the  sufferer,  the  causa- 
tion of  which  is  now  clear  to  us,  are  in  general  terms  as 
follows  :  Morning  nausea  or  sickness,  with  ejection  of 
"  phlegm "  from  the  stomach,  followed  by  relief  and  by 
some  hunger  ;  defective  appetite  and  taste ;  pain  after 
the  consumption  of  solid  food,  flatidence,  and  niarhed 
thirst. 

The  condition  of  the  mouth  reflects  the  state  of  the 
stomach.  The  tongue  is  always  furred,  never  clean  ;  the 
throat  is  always  congested  ;  the  breath  is  foul  ;  the  teeth, 


288  DISEASES    DUE    TO    IMPERFECT   DIGESTION. 

unless  scrupulous  care  is  taken  of  them,  are  coated  with 
mucus  and  with  deposits  of  tartar. 

TJce  treatment  of  this  condition  can  only  he  palliative. 

All  injudicious  stimulation  of  the  stomach  must  cease, 
only  a  little  alcohol  being  allowed  at  meal  times,  if  essen- 
tial to  necessary  digestion. 

The  food  must  be  of  the  simplest  form,  and  of  the  kind 
least  likely  to  ferment.  Fats  must,  to  a  large  extent,  be 
shunned.     The  general  health  must  be  raised. 

As  regards  medication,  no  drug,  except  bismuth,  affords 
much  relief  (see  Formula  No.  6  in  Appendix),  and  its  use 
may  be  continued,  at  intervals,  for  years,  w^ithout  harm. 
Fresh  and  dry  vegetable  charcoal  and  the  black  oxide  of 
manganese  are  sometimes  useful,  but  are  inferior  to  bis- 
muth, and  considerably  more  objectionable  as  constant 
medicines,  being  moreover  gritty  and  unpalatable.  When 
constipation  and  flatulence  are  sources  of  trouble  the  bis- 
muth inay,  for  a  day  or  two,  be  combined  with  rhubarb, 
soda,  and  oil  of  peppermint  (see  Formula  No.  7,  Appendix). 

(c)  Indigestion  due  to  Degenerations  of  the  Stomach. — In 
chronic  gastric  catarrh  we  have  witnessed  one  variety  of 
degeneration,  the  result  of  long-standing  inflammation  ; 
there  are  two  other,  fairly  common,  forms,  which,  in  a 
popular  work,  it  will  l>e  my  duty  only  to  mention,  since 
neither  of  them  can  rightly  become  a  subject  for  self- 
treatment.  Tliese  are  Ulcer  of  the  Stomach  and  Cancer  of 
the  Stomach. 

The  existence  of  the  former  of  these  complaints  may  be 
suspected  when,  with  signs  of  acute  indlgestlo7i,  vomiting 
of  bright  red  blood  is  from  time  to  time  witnessed,  a  symp- 
tom which  is  rare  in  other  conditions  than  this.  It  is  wor- 
tliv  also  of  notice  that  in  the  female  sex  ulcer  of  the  stom- 
ach is  of  commoner  occurrence  than  in  males,  and  that  it 
selects  almost  exclusively  female  domestics  between  eigh- 


ORGANIC    DISEASES    OF    THE    STOMACH.  289 

teen  and  thirty  years  of  age/''  In  the  male  it  is  not  only 
comparatively  rare,  but  the  average  age  at  which  it  oc- 
curs is  also  much  higher,  generally  between  fifty  and  sixty 
years,  and  the  employment  followed  is  usually  one  which 
involves  sustained  pressure  on  the  gastric  region.  Shoe- 
makers and  clerks  are  thus  common  sufferers. 

Cancer  of  the  Stomach  is  a  disorder  so  grave,  so  rapidly 
progressive,  and  so  invariably  fatal,  that  if  I  mention  a 
few  of  its  prominent  symptoms  it  is  only  to  prevent  the 
hypochondriacal  dyspeptic  from  imagining  himself  the 
subject  thereof.  It  is  rare  under  fifty  years  of  age  ;  its 
onset  is  severe  ;  its  progress  unchecked  ;  its  symptoms 
every  day  more  alarming.  Severe  dyspepsia  is  generally 
the  first  symptom.  Loss  of  flesh  is  early  noticeable  ;  and 
vomiting,  after  the  first  month  or  two,  becomes  almost  in- 
cessant and  is  characterized  by  the  appearance  of  a  sub- 
stance like  coffee- ground,  due  to  blood  altered  in  appear- 
ance by  the  gastric  juice.  Two  years  of  life  is  the  utmost 
that  may  be  expected  for  the  subject  of  gastric  cancer,  the 
vast  majority  of  sufferers  dying  within  a  twelvemonth. 

Dilatation  of  the  Stomach  is  an  occasional  sequence  of 
gastric  ulcer,  and  may  be  caused  by  contraction  of  the 
pyloric  orifice  of  the  stomach,  or  by  adhesion  of  the  stom- 
ach to  the  intestines  or  to  the  liver,  and  consequent  fixa- 
tion of  the  organ,  all  of  which  are  not  uncommon  sequences 
of  gastric  ulcer. 

Derangements  of  the  Intestine. 

We  now  pass  to  the  disorders  of  that  portion  of  the  ali- 
mentary track  which  lies  beyond  the  stomach. 

*  There  is  some  reason  to  think  that  this  may  be  due  to  the  pres- 
sure of  corset  hones  on  a  stomach  slightly  congested  by  a  diet  richer 
than,  or  different  to,  that  to  which  the  stomach  has  been  hitherto  ac- 
customed. 
13 


290  DISEASES    DUE    TO    IMPERFECT   DIGESTION. 

Like  those  which  we  have  just  reviewed,  these  may  be 
the  result  of  mere  hick  of  tone,  of  inflammatory  processes, 
or  of  deg^eneration. 

The  diagnosis  of  intestinal  disorders  is  by  no  means  so 
easy  as  that  of  analogous  processes  in  the  stomach,  for  no 
search  light  can  penetrate  to  the  seats  of  disorder,  and  no 
sample  of  the  digestive  juices  can  be  procured.  Further- 
more, gastric  derangement,  by  involving  imperfect  diges- 
tion of  food,  is  often  the  sole  cause  of  the  symptoms  set 
up  in  the  further  reaches  of  the  alimentary  canal,  and  may 
thus  lead  to  a  suspicion  of  intestinal  mischief  which  does 
not  exist. 

(a)  Intestinal  Derangement,  resulting  from  Loss  of  Tone. 
— Lack  of  tone,  like  the  analogous  state  in  the  stomach,  is 
not,  in  the  ordinary  sense  of  the  word,  a  disease,  but  takes 
its  rise  in  a  loss  of  muscular  power,  usually  general  to  the 
whole  body.  It  may  be  merely  transitory,  due  to  some 
temporary  cause  that  induces  feebleness,  or  it  may  be  a 
characteristic  of  the  individual  and  last  a  whole  lifetime, 
as  we  see  in  many  females,  or  may  be  a  perfectly  normal 
phenomenon  of  old  age. 

Like  the  stomach,  the  intestine  is  provided  throughout 
its  whole  extent  with  a  muscular  wall  which  plays  an  im- 
portant part  in  the  work  of  alimentation,  by  turning  over 
and  presenting  alternatively  to  the  digestive  fluids  each 
joart  of  its  liquid  contents,  while  at  the  same  time  urging 
the  whole  mass  towards  the  outlet. 

It  is  not  hard  to  guess  the  consequences  of  a  deficiency 
in  this  muscular  power.  In  the  first  place,  there  will  be 
defective  digestion  accompanied  by  ^oy\\q  fermentation  and 
a  consequent  development  of  gas ;  and  in  the  second  place, 
unless  the  fermenting  food  irritates  powerfully  the  intes- 
tinal wall,  there  will  also  bo  constipation. 

In  conjunction  with  this  loss  of  muscular  tone  there  will 


TREATMENT    OF   ATONIC    DYSPEPSIA.  291 

often  be  foiincl,  thougli  it  docs  not  of  necessity  follow, 
some  concurrent  deficiency  in  quantity  and  quality  of  the 
intestinal  juices,  a  defective  secretion  of  bile,  of  pancreatic 
fluid,  and  of  the  secretion  of  the  intestinal  glands  ;  but,  as 
the  class  of  sufferers  from  loss  of  tone  are  usually  very 
small  eaters,  this  lack  of  digestive  fluids  is  but  rarely  to 
be  reckoned  as  a  large  factor  in  the  trouble. 

The  aged,  and  the  more  delicate  of  the  female  sex,  fur- 
nish us  with  the  best  exam.ples  of  this  atonic  intestinal 
dyspepsia.  Their  principal  complaint  is  often  of  flat- 
ulence, tiie  intestinal  gas  either  remaining  stationary  in 
one  coil  of  dilated  bowel,  and  producing  pain,  or  rolling, 
with  much  noise,  from  one  part  of  the  large  intestine  (the 
colon)  to  another.  It  is  needless  to  say  that  nothing  but 
lack  of  muscular  tone  can  account  for  the  permanence  of 
such  a  symptom. 

The  treatment  is  simple,  and,  when  resolutely  carried 
out,  always  successful.  If  in  old  age  be  found  the  cause, 
attempts  to  improve  the  condition  by  such  drugs  as  strych- 
nia and  nux  vomica  are  not  only  unreasonable,  but  must, 
in  the  long  run,  render  matters  worse.  Attention  is  to  be 
directed  mainly  to  the  food.  This  should  consist  of  nutri- 
tive material  containing  much  waste,  and  therefore  a  full 
measure  of  stimulating  power.  To  the  vegetable  world 
we  may  mainly  look  for  such  food.  Brown  bread,  por- 
ridges of  coarse  meal,  fruit,  vegetables  of  every  digestible 
sort — from  which  sometimes  the  members  of  the  cabba2:c 
tribe  have  to  be  excluded— should  occupy  an  important 
place  in  the  dietary.  These  will  not  only  rouse  in  a  whole- 
some and  unobjectionable  manner  the  muscular  function 
of  the  bowel,  but  do  not  themselves  contain  any  material 
capable  of  undergoing  rapid  fermentation.  Plenty  of  fat 
bacon,  and  bacon  from  its  fatness  is  scarcely  to  be  reckoned 
as  a  meat,  may  be  allowed  for  breakfast,  and  a  little  fish. 


292  DISEASES    DUE    TO    IMPERFECT    DIGESTION. 

poultry,  or  game  at  dinner  ;  otherwise  the  food  should  be 
vegetarian  in  character,  excepting  that  cream,  fresh  butter, 
and  milk,  if  they  agree  well,  may  be  allowed.  Coffee  is 
the  best  beverage  for  breakfast  ;  white  wine,  sound  cider, 
light  ale,  or  diluted  w^hisky  for  dinner. 

Reasonable  exercise  and  all  other  necessary  means  for 
the  maintenance  of  a  fair  state  of  general  health  should  be 
sought  after. 

It  is  but  rarely,  when  such  treatment  is  conscientiously 
undertaken  by  the  patient,  that  recourse  need  be  had  to 
medication.  In  any  case  nothing  more  than  one  of  the 
very .  excellent  flexible  Cascara  capsules  of  Duncan  & 
Flockhart,  of  Edinburgh,  need  be  taken,  after  dinner, 
every  second  or  third  day. 

It  is  well  to  remember  that,  in  old  age,  a  daily  evacua- 
tion of  the  bowel,  on  a  rational  dietary,  is  not  essential  to 
health. 

When  the  sufferer  is  a  lady  not  beyond  middle  life,  or 
a  delicate,  sedentaiy  man,  the  rational  aim  in  treatment  is 
the  re-establishment  of  that  muscular  tone  which  belongs, 
of  right,  to  the  j^re-degeneration  periods  of  life. 

The  commonest  type  of  sufferer  is  the  well-to-do  lady, 
often  under  thirty,  and  quite  unused  to  muscular  exertion. 
Her  treatment  hitherto  has  probably  been  confined  to  the 
avoidance  of  tea,  frequent  change  of  air  and  scene,  an  oc- 
casional mild  aperient  and  tonic,  various  small  alterations 
in  her  dietary,  and  perhaps  an  occasional  visit  to  some 
spa  or  watering-place. 

The  net  result  of  such  a  line  of  treatment  has  been  jiil ; 
temporary  improvement  having  always  given  place  to  re- 
lapse. 

The  following  is  the  only  plan  on  which  a  permanent 
cure  can  be  expected: 

Both  the  muscular  and  nervous  systems  must  be  strength- 


now  TO  RESTORE  TONE  TO  THE  SYSTEM.      293 

ened,  for  though  the  muscles  store  the  energy,  the  nerves 
discharge  it,  and  are  concerned,  therefore,  equally  in  the 
cure.  Active  muscular  exercise  must  be  taken,  and  to 
render  this  possible  some  brief  alterations  in  the  patient's 
ordinary  apparel  are  generally  called  for.  Every  con- 
striction of  the  body  that  interferes  with  the  freest  move- 
ment of  the  muscles  must  be  removed,  and  the  weight  of 
the  garments  worn  should  be  reduced  to  the  lowest  level 
consistent  with  health  and  the  reasonable  demands  of 
fashion,  while  even  this  modified  burden  must  be  dis- 
tributed as  evenly  over  the  body  as  possible. 

With  reference  to  one  article  of  attire,  the  corset,  much 
that  is  antagonistic  to  the  canons  of  common-sense  has 
been  written  and  spoken.  It  is  neither  necessary,  and 
plainly  it  is  not  possible,  to  abolish  this  garment,  as  the 
medical  journals  and  the  one-idea  men  would  have  us  at- 
tempt. It  should  be  treated  as  the  Fathers  of  the  Society 
of  Jesus  are,  correctly  or  incorrectly,  said  to  have  done 
the  Chinese  idols,  tenderly  and  cautiously,  with  a  view  to 
the  gradual  removal  of  its  objectionable  features. 

For  practical  hints  on  this  and  kindred  subjects,  I  must 
again  refer  the  reader  to  the  useful  book  by  Dr.  Anna 
Kingsford,  entitled  "  Health,  Beauty,  and  the  Toilet." 

Having  seen,  then,  that  the  clothing  shall  form  no  bar 
to  muscular  movement,  exercise  must  be  resolutely  under- 
taken. Swimming,  riding,  rowing,  cycling,  tennis,  skat- 
ing, each  and  every  form  of  exercise  that  brings  the  in- 
dividual into  contact  with  fresh  air  and  fresh  faces,  that 
rouses  the  mind  as  well  as  the  body,  must,  according  to 
the  circumstances  present,  be  indulged  in.  The  special 
weaknesses  of  females,  which  are  supposed  to  require,  for 
their  alleviation,  rest  and  quiet,  may  in  all  but  very  ex- 
ceptional cases  be  disregarded.  They  are  the  coiiseqiiences 
of  a  generally  relaxed  and  debilitated  muscular  system, 


294     .        DISEASES    DUE    TO    IMPERFECT    DIGESTIOX. 

and  are  to  be  cured  only  by  an  all-round  elevation  of  tone. 
Rest  alleviates  present  discomfort  only,  while  indefinitely 
postponing  all  hope  of  a  cure. 

Of  course  the  exertion  taken  must,  at  first,  be  compara- 
tively little,  for  exercise  pushed  to  the  extreme  fatigue 
point  becomes  itself  enervating.  It  must  be  commenced 
cautiously  and  gradually  increased. 

In  some  few  cases  passive  exercise,  such  as  massage, 
may,  in  the  absence  of  sufficient  resolution  on  the  part  of 
the  patient,  be  at  first  substituted  for  other  forms. 

{}j)  Intestinal  Derangement,  the  result  of  Inflammatory 
Processes. — It  cannot  with  accuracy  be  said  that  inflamma- 
tory disorders  in  the  intestine,  analogous  to  those  so  com- 
mon in  the  res^ion  of  the  stomach,  are  verv  often  met  with, 
for  the  bowel  is  evidently  not  so  subject  as  is  the  latter 
organ  to  direct  and  powerful  stimulation. 

Sometimes,  indeed,  gastric  catarrh  will  extend  beyond 
the  stomach  for  some  little  distance  into  the  bowel,  but 
even  then  such  extension  can  only  be  surmised  from  the 
appearance  of  mild  jaundice,  the  result  of  swelling  of  the 
intestinal  mucous  membrane  at  that  point  where  the  bile 
makes  its  exit. 

Indeed,  general,  acute,  and  severe  catarrh  of  the  bowel 
linings,  except  in  that  rare  complaint,  enteritis,  may  be 
said  to  be  unknown,  though  a  mild  and  subacute  form  of 
it  must  be  set  up  every  time  that  acrid  products  of  fer- 
mentations pass  the  stomach  and  excite  the  intestine  to 
those  violent  and  painful  contractions  which  terminate  in 
the  expulsion  of  the  offending  mass. 

But  a  chronic  state  of  Intestinal  Catarrh  is  by  no  means 
unfrequent,  especially  in  scrofulous  and  badly  fed  children. 
Such  pass  large  quantities  of  mucus,  and  with  it  not  un- 
frequently  thousands  of  thread-worms,  which  find  in  such 
mucus  a  convenient  habitat,  both  these  and  the  less  com- 


INFLAMMATORY    DISORDERS    OF    THE    INTESTINE.        295 

men  but  much  larger  round  worm  rarely  locating  them- 
selves in  healthy  subjects.  These  parasites  are  to  be 
viewed  as  sequences,  not  antecedents  and  causes,  of  in- 
testinal disorder.  The  case  of  tape-worm  is,  however, 
among  intestinal  parasites,  an  exception,  for  it  requires  no 
such  special  preparation  for  its  reception,  but  will  affix 
itself  in  the  healthiest  intestine. 

The  prominent  symptom,  often  indeed  the  only  outward 
and  visible  proof  to  the  laity,  of  the  existence  of  inflam- 
matory bowel  disorder,  is  diarrhoea,  a  very  natural  con- 
sequence of  the  outpouring  of  fluid  which  ensues  on  in- 
testinal irritation,  though  in  saying  this  I  must  add  the 
caution  that  diarrhoea  is  much  more  often  due  to  faulty 
digestion  in  the  region  of  the  stomach  than  to  the  exist- 
ence of  any  sj^ecial  primary  intestinal  disorder. 

The  treatment  is  again  very  clear.  The  bowel  must  first 
be  emptied  of  all  irritating  products  by  some  very  simple 
aperient,  not  itself  an  irritant,  and  castor  oil  is  the  only 
drug.  There  are  several  ways  in  which  the  administration 
of  this  medicine  may  be  made  easy  for  delicate  stomachs 
{vide  Appendix,  Formula  No.  9). 

Then  the  bowel  must  be  soothed  and,  as  far  as  possible, 
rested.  This  is  only  to  be  done  by  a  wise  selection  of 
food.  Bland  but  nourishing  liquids,  and  these  only  in  the 
smallest  quantity,  should  be  taken.  Brand's  essence,  Val- 
entine's meat-juice,  Benger's  meat  preparations,  etc.,  are 
to  be  commended.  These  undergo  probably  almost  j)er- 
fect  absorption  in  the  stomach.  Light  meat  jellies  may 
also  be  allowed,  also  oysters.  Barley  water,  rice  water, 
whey,  and  solutions  of  malt  extract  (^.  e.,  grape-sugar) 
may  be  allowed,  and  all  contain  some  nutrient  properties. 
Milk  is  often  well  avoided,  but  sour  buttermilk  and  kou- 
miss may  generally  be  allowed.  A  light,  dry,  sparkling 
wine,  preferably  red,  or  even  a  little  very  dilute  spirit,  is 


296  DISEASES    DUE    TO    IMPERFECT    DIGESTIOX. 

permissible  in  cases  where  the  stomach  is  qnite  sound, 
but  malt  liquors,  cider,  sweet  wines,  and  coffee  must  bo 
shunned.  Rest  in  bed  in  a  well-warmed  room  is  a  great 
adjunct  to  treatment,  and  helps  to  prevent  considerably 
the  loss  of  weight  and  muscular  power  which  might  other- 
wise ensue  on  a  restricted  dietary. 

Among  drugs,  few  are  of  any  service  except  castor  oil, 
which,  in  small  doses  of  one  to  three  teaspoonfuls,  may  be 
administered  every  second  or  third  day.  In  a  few  cases 
opium  must  be  had  recourse  to.  Then  the  opium  tabloids 
of  Burroughs  &  Welcome  (two  drops  of  laudanum  in 
each  tabloid)  make  a  palatable  method  of  giving  the  drug, 
and  an  adult  may  consume  from  five  to  ten  of  such  tabloids 
per  diem.     They  should  never  be  given  to  children. 

On  recovery,  the  return  to  a  full,  mixed  diet  must  be 
cautious  and  gradual. 

(c)  Intestinal  Derangement,  the  result  of  Degeneration. — 
Of  these  there  are  unfortunately  several,  which,  as  they 
are  unsuited  to  a  course  of  self-medication,  I  shall  only 
lightly  touch  upon. 

Cancer  of  the  Bowel  is  rare  under  forty  years  of  age, 
and  may  affect  any  part  of  its  course.  The  symptoms 
vary  according  to  the  site,  but  are  severe  and  progressive. 
The  tumor  to  which  this  malignant  process  gives  rise  may 
generally  be  felt,  even  early  in  the  case,  by  careful  ma- 
nipulation. 

Ulceration  of  the  Bowel  may  occur  in  various  forms. 

When  seen  in  that  part  of  the  intestine  called  the  duo- 
denum, which  is  the  immediate  continuation  of  the  stom- 
ach, the  ulcer  is  single  and  often  large  and  ragged.  The 
rationale  of  its  causation  is  obscure,  but  it  is  not  an  un- 
common sequence  of  extensive  burns  on  any  part  of  the 
surface  of  the  body. 

In  other  portions  of  the  intestine  ulceration  may  be  sin- 


DISORDERS    OF    SECONDARY    DIGESTION.  297 

gle,  and  is  then  generally  iDrocluced  by  the  presence  and 
pressure  of  some  foreign  body,  such  as  a  gall  stone ;  but 
in  the  vast  majority  of  cases  it  is  multiple,  and  due  to  a 
general  blood  derangement  and  consequent  breakdown  of 
intestinal  glands.  Examples  of  this  we  see  in  typhoid  fevei\ 
in  tuberculosis,  and  in  syphilis.  In  severe  dysentery  multi- 
ple ulceration,  consequent  on  severe  inflammation  of  the 
coats  of  the  large  bowel,  is  present,  and  renders  the  treat- 
ment prolonged  and  often  unsuccessful. 

II.  DISORDERS  OF  SECONDARY  DIGESTION. 

Secondary  digestion  carries  the  food  from  the  point  of 
its  absorption  by  the  alimentary  canal  to  its  exit  through 
the  liver  into  the  general  blood-stream. 

Hitherto  our  foods  have  been  three  in  character — albu- 
men, starch  or  sugar,  and  fat;  we  may  now  eliminate  the 
last  named  of  these,  as  it  does  not  pass  through  the  liver, 
but  follows  a  separate  course  of  its  own  into  the  general 
blood-stream. 

Absorbed  albumen  and  sugar  (for  starch  and  cane-sugar 
are  now  represented  by  the  one  substance,  grape-sugar) 
travelling  by  the  portal  vein,  reach  the  liver,  and  there 
undergo  a  species  of  arrest,  most  durable  and  marked  in 
the  case  of  sugar,  less  so  in  that  of  albumen. 

These  arrested  substances — now  in  the  forms  of  insoluble 
albumen  and  animal  starch  or  glycogen — undergo  a  re- 
digestion  at  the  hands  of  the  blood  brought  in  a  small 
stream  to  the  liver  by  the  hepatic  artery. 

The  glycogen  is  by  this  process  sloicly  reconverted  to 
grape-sugar,  in  which  form  it  passes  the  liver  by  the  one 
channel  of  exit,  the  hepatic  vein,  and  flows  onward,  un- 
checked, to  the  heart.  The  albumen  has  to  submit  to  a 
more  complex  change ;  much  of  it  is  oxidized  to  urea  by 
the  oxygen  in  the  blood  of  the  hepatic  arterv,  a  second 
13- 


298  DISEASES    DUE    TO    IMPERFECT    DIGESTION. 

portion  is  cast  off,  mixed  with  excreta  from  the  hepatic 
artery,  as  bile,  while  one  part  only  is  reconverted  to  solu- 
ble albumen  and  becomes  blood  serum,  and  with  the 
grape-sugar  passes  by  way  of  the  hepatic  vein  on  towards 
that  great  arterial  pump,  the  heart. 

It  is  now  clear  that  disorders  of  secondary  digestion 
must  depend  almost  exclusively  both  on  the  character 
and  on  the  amount  of  the  blood  supplied  by  the  hepatic 
artery. 

SujDpose,  now,  that  the  supply  of  this  fluid  be,  from  any 
cause,  excessive — what  then  ?  We  shall  evidently  have  an 
excess  of  grape-sugar,  quite  beyond  the  combustion  pow- 
ers of  the  body,  poured  into  the  hepatic  vein,  and  such 
excess  of  grape-sugar  will  run  off  by  the  kidneys,  excit- 
ing them  to  over-action,  and,  as  it  can  pass  out  only  in  a 
state  of  solution,  it  will  necessarily  rob  the  blood  of  much 
water. 

It  is  clear  that,  in  such  a  state  of  matters,  there  will  be 
a  constant  hunger,  an  incessant  demand  for  more  and 
more  cane-sugar  and  starch  to  fill  the  place  of  that  so  lav- 
ishly converted  to  grape-sugar  by  the  liver.  There  will 
also  be  great  dryness  of  the  skin  of  the  body,  for  the  blood 
will  extract  fluid  from  the  tissues  to  make  up  for  its  loss 
of  water ;  finally,  there  will  be  considerable  thirst.  But 
there  will  be  other  sjmiptoms,  for  the  whole  body  will 
suffer,  the  incessant  eating  and  drinking  will  soon  overtax 
the  digestive  powers'  of  the  stomach  and  lead  to  their  fail- 
ure, and  on  this  will  ensue  failure  of  general  nutrition, 
and,  towards  the  end,  consumjytion,  attacking  the  lungs, 
which  are  called  on  to  supply  from  the  air  oxygen  in  ex- 
cess of  the  ordinary  amount. 

Such  are  the  principal  sequences  of  an  excessive  pour- 
ing into  the  liver  of  arterial  blood  by  the  hepatic  artery. 
Now,  supposing  that  the  cause  of  such  over-supply  bo 


THE    ORIGIN    OF    DIABETES    AND    GOUT.  299 

some  permanent  and  incurable  paralysis  of  the  nerve  which 
should  keep  the  minute  offshoots  of  the  hepatic  artery 
contracted,  the  sequence  of  events  sketched  will  persist, 
and  the  patient  will  die  of  diabetes  mellitus;  but  suppos- 
ing, as  is  more  often  the  case,  that  a  mere  temporary  over- 
pressure exists  in  the  hepatic  artery,  then  again  we  shall 
liave  the  group  of  phenomena  which  must  still  go  by  the 
same  name — ^.  e.,  diabetes  mellitus — but  the  disorder  is 
transient  and  probably  curable. 

Thus,  Glucosuria — i.  e.,  Diabetes  mellitus — which  may  be 
either  a  grave  and  permanent  or  a  trivial  and  transient 
disorder,  is  a  direct  consequence  of  failure  of  secondary 
digestion. 

But  what  will  be  the  effects  on  albumen  of  an  excess  of 
this  hepatic  arterial  blood  supply  ?  Surely  an  excess  of 
albumen  in  the  blood,  some  of  which,  as  in  the  case  of 
grape-sugar,  may  travel  away  by  the  kidneys — in  other 
words,  we  have  a  common  and  not  formidable  variety  of 
albuminuria,  together  with  some  temporary  excess  of  urea 
and  of  bile  in  the  urine. 

But  suppose,  as  a  consequence  of  general  inaction,  or  of 
some  poison — such  as  lead — in  the  general  blood-stream, 
that  the  blood  in  the  hepatic  artery  be  poor  in  oxygen  or 
actually  contaminated — what  then  ?  Evidently  there  will 
be  a  defective  formation  of  serum  albumen,  and  an  excess 
of  albumen  will  be  left  in  the  liver  to  undergo  combustion 
to  urea  and  change  into  bile  acids.  But  if  the  oxygen 
supply  be  defective,  how  is  urea — a  product  of  oxidized 
albumen  —  to  be  efficiently  made  ?  Some  urea  will  be 
formed,  and  an  imperfectly  oxidized  form  of  urea — uric 
acid — will  accompany  it,  and,  escaping  into  the  general 
blood-stream,  will  set  up,  if  the  kidneys  be  not  active 
enough  to  eliminate  it  rapidly.  Gout.  But  the  excess  of 
albumen  need  not  go  to  form  uric  acid;  it  may,  under 


300  DISEASES    DUE    TO    IMPERFECT    DIGESTION. 

some  conditions,  be  changed  to  bile  acids,  and  these,  if  in 
excess,  will  clog*  the  liver  and  produce  Biliousness.  And 
the  blood  in  the  hepatic  artery  assists  also  in  bile  forma- 
tion, and,  if  impure,  will  itself  be  a  direct  cause  of  biliary 
derangement;  thus  it  may  cast  out  such  poisons  as  lead  and 
arrest  bile-flow  and  lead  to  the  same  disorder  {i.  e.,  Bil- 
iousness), or  it  may  cast  out  in  excess  a  very  peculiar  sub- 
stance, supposed  to  be  the  result  of  nerve  waste,  and  called 
cholesterin,  and  then,  in  addition  to  biliousness,  we  shall 
have  bile  sand,  bile  gravel,  or  Gall  stones  produced. 

But,  in  an  earlier  chapter,  we  have  seen  that  an  exces- 
sive supply  of  albumen  to  the  liver  may  also  lead  to  gout 
and  biliousness  (and  even  to  rheumatism),  and  now  we 
understand  clearly  why  gout,  biliousness,  and  one  variety 
of  albuminuria  may  be  due  to  one  of  two  apparently  very 
diverse  causes,  either  to  faults  of  excess  in  the  food  or  to 
defects  in  the  general  arterial  blood-stream,  telling,  as  such 
must  tell,  by  way  of  the  hepatic  artery,  on  the  functions 
of  the  liver.  There  are  wiseacres,  yet  in  the  flesh,  who 
wonder  how  lead  poisoning  can  cause  gout  and  bilious- 
ness, and  why  great  nervous  depression,  or  worry,  may 
also  tend  to  the  same  derangement,  and  puzzle  over  the 
solution  of  a  problem  which  modern  elementary  physiol- 
ogy, plus  a  little  easy  thought,  renders  clear,  even  to  the 
least  intelligent. 

Of  the  Degenerative  Diseases  of  the  liver  it  is  not  my  pur- 
pose to  treat.  Indeed,  the  principal  ones.  Cirrhosis  of  the 
liver  and  waxy  and  fatty  degenerations,  are  rather  to  be 
viewed  as  local  indications  of  a  general  decline  of  bodily 
vigor  than  as  liver  disorders,  and  give  rise  to  no  symp- 
toms specially  indicative  of  that  arrest  of  liver  function  to 

*-I  have  explained  fully,  in  a  small  book  entitled  "Biliousness," 
in  what  way  an  excess  of  bile  acids  will  produce  this  block  in  the 
liver. 


DISORDERS    OF    TERTIARY    DIGESTION.  301 

which  they  inevitably  lead.  Acute  yellow  Atrophy  of  the 
Liver  is  a  terribly  fatal  but  exceedingly  rare  disorder  of 
unknown  causation  ;  while  Cancer  in  the  Liver  produces 
swelling,  pain,  and  often  abscess-formation,  together  with 
abrogation  of  hepatic  functions  accordino-  to  its  size  and 
situation. 

III.  DISOEDERS  OF  TERTIARY  DIGESTION. 

We  now  have  to  deal  with  the  grape-sugar  and  serum 
albumen  in  the  blood,  and  also  with  the  fat  which,  though 
by  other  ways,  has  found  its  way  also  into  the  same 
stream. 

These  three  substances,  be  it  remembered,  are  in  solu- 
ble form,  but,  owing  to  the  rapidity  of  the  current  and 
the  thickness  of  the  walls  of  the  channels  in  which  they 
find  themselves,  they  cannot  pass  out  among  the  tissues, 
but  are  swept  on  to  the  right  side  of  the  heart. 

On  reaching  that  organ  they  are  at  once  pumped  to  the 
lungs.  Here  the  red  corpuscles  of  the  blood  take  up  a 
store  of  oxygen,  getting  rid  of  the  carbonic  acid  which 
caused  them  to  assume  in  the  veins  a  dark  purple 
shade. 

Back  from  the  lungs  the  foods  come  to  the  heart,  but 
this  time  to  the  powerful  left  side  of  it,  whence  they  are 
immediately  pumped  into  the  arteries,  which  divide  and 
subdivide,  till  at  last  the  grape-sugar,  fat,  and  albumen 
find  themselves  once  more  in  channels  with  but  a  single 
membranous  w^all,  and  moving  very  leisurely  along.  At 
this  point,  being  colloids,  they  ooze  out  among  the  cells, 
the  grape-sugar  and  fat  to  undergo  combustion  and  to 
store  the  cells  with  heat-energy,  the  products  of  combus- 
tion, water  and  carbonic  acid,  finding  eventually  their  way 
back  into  the  blood-stream,  wdiile  the  albumen  incorpo- 
rates itself  by  chemical  action  Avitli  the  cells,  supplying 


302  DISEASES    DUE   TO    IMPERFECT    DIGESTION. 

one  more  step  in  the  march  of  the  cells  to  death,  and  pro- 
ducing thereby  one  more  fraction  of  that  complex  phe- 
nomenon called  life. 

The  cells  throw  off  waste,*  which,  eventually  assuming 
the  form  of  urea,  is  pumped  by  the  action  of  the  muscles 
forward  along  the  lymphatics  into  the  blood-stream  and 
voided  with  the  urine. 

What  right,  may  the  reader  ask,  has  such  a  process  to 
be  ranked  as  a  third  stage  of  digestion  —  should  it  not 
properly  be  styled,  as  it  usually  is,  an  assimilation  ?  As 
far  as  the  grape-sugar  and  fat  are  concerned  there  is  no 
such  thing,  evidently,  as  assimilation,  while  the  action  of 
albumen  on  the  cells  is  a  chemical  process,  purely  and 
simply,  a  reconversion  of  crystalloid  albumen  to  a  colloid 
state,  therefore  more  of  a  digestive  process  than  anything 
else. 

The  Disorders  of  Tertiary  Digestion,  then,  may  arise  (a) 
from  a  lack  of  oxygen  in  the  red-blood  corpuscles  and  a 
consequent  failure  in  the  combustion  of  grape-sugar  and 
fat;  this  ends  in  Obesity;  or  (b)  from  deficient  muscular 
power,  leading  to  the  accumulation  of  waste  nitrogenous 
debris  in  the  muscles  and  the  appearance  of  uric  acid  and 
other  kindred  compounds  in  place  of  urea,  and  hence  to 
Rheumatism;  or  (c)  from  degeneration  or  temporary  de- 
bility of  the  cells,  also  ending  in  the  last-mentioned  com- 
plaint ;  or,  lastly  (f?),  from  other  derangements  of  the 
lungs,  skin,  and  kidneys,  which  are  concerned  in  the  final 
expulsion  from  the  body  of  the  products  of  tertiary  di- 
gestion. 

Let  us  now  devote  a  few  lines  to  the  treatment  of  these 
derangements  of  secondary  and  tertiary  digestion. 

*  This  is  styled  cell  waste  and  is  the  by-product  in  the  chemical 
process  just  spoken  of. 


TREATMENT    OF    DIABETES.  303 

Treatment  of  Diabetes. — This  will  depend  entirely  en 
the  underlying  cause. 

If,  as  is  common  in  the  aged,  the  appearance  of  grape- 
sugar  in  the  urine  {i.  e.,  the  glucosuria)  is  due  to  calcifica- 
tion of  the  arteries,  or  is  traceable  to  a  general  rise  of 
arterial  pressure  consequent  on  the  contraction  of  degen- 
erating kidneys,  or  to  an  over-vigorous  heart;  and  if, 
moreover,  the  grape-sugar  in  the  urine  leads  to  excessive 
urination,  to  thirst,  to  a  constant  craving  for  food,  and  to 
the  other  symptoms  already  alluded  to  as  characteristic 
of  severe  diabetes,  then  it  will  become  advisable,  in  the 
first  place,  to  reduce  the  amount  of  carbo-hydrates  {i.  e., 
starch  and  sugar)  consumed.  Saccharine  or  glycerine 
may  entirely  replace  sugar,  and  the  foods  most  rich  in 
starch — namely,  bread,  potatoes,  and  the  various  farina- 
ceous compounds — may  be  cut  down  in  amount  till  the 
more  troublesome  symptoms  dependent  on  the  presence 
of  excess  of  grape-sugar  in  the  blood  have  subsided.  A 
liberal  supply  of  fat  must  be  allowed- to  replace  the  lack 
of  carbo-hydrates,  while  an  increase  in  the  albuminous 
food  (all  albumen  undergoes  some  combustion,  and  is 
therefore,  to  a  slight  extent,  a  fuel-food)  and  a  reasonable 
amount  of  unsweetened  spirit  or  of  unfortified  wine  are 
also,  often,  measures  of  utility. 

If,  however,  in  this  class  of  diabetic  there  is  present 
simply  a  glucosuria  unattended  by  any  disturbance  of  the 
bodily  comfort — and  this  is  the  general  rule — then  it  is 
unnecessary  to  resort  to  any  dietetic  restrictions  whatever; 
or  at  most  to  but  slight  and  gradually  carried  out  reduc- 
tions in  the  carbo-hydrate  foods,  any  sudden  change,  such 
as  is  too  often  adopted  during  the  panic  which  seizes  both 
doctor  and  invalid  when  the  glucosuria  is  first  discovered, 
being  apt  to  lead  to  graver  disaster  than  the  symptoms 
themselves  could  have  induced,  if  left  untreated. 


304  DISEASES    DUE    TO    IMPERFECT    DIGESTION. 

But,  perhaps,  the  largest  of  the  various  classes  into 
which  diabetics  may  be  divided,  comprises  the  sufferers 
from  some  transient  form  of  liver  incapacity,  such  as  gout 
or  biliousness — those,  in  fact,  who  have  inherited  livers 
unable  to  bear  the  normal  strain.  In  such  as  these  gluco- 
suria  for  long  periods,  or  even  as  a  constant  symptom, 
may  be  found  to  exist,  hut  there  is  with  it  no  loss  of  bod- 
ily health  fairly  traceable  to  it,  and  there  is  rarely  any 
excess  of  urea  excreted  by  the  kidney. 

In  this  class,  the  treatment  must  be  purely  hygienic, 
directed  to  a  general  improvement  of  health,  while  in  free- 
livers  a  course  of  treatment  by  some  aperient  mineral  wa- 
ter may  materially  assist  a  return  to  the  normal  state. 

Then,  lastly,  we  have  the  sufferer  from  the  dangerous 
variety  of  diabetes,  that  in  which  there  is  not  only  some 
grave  brain  mischief,  paralyzing  the  poAver  of  temporary 
detention  possessed  by  the  liver  over  grape-sugar,  but 
usually  also — as  proved  by  the  excess  of  urea  which  ac- 
companies that  of  sugar  in  the  urine — other  and  wider 
interference  with  nutritive  processes.  In  this  class  the 
patient's  outlook  is  grave  ;  the  younger,  the  graver.  Drugs 
act,  in  conjunction  with  other  means,  only  as  palliatives. 
Of  these,  opium  and  one  of  its  derivatives,  codeina,  are 
the  best,  but  no  reliance  on  their  curative  powers  is  to  be 
encouraged.  Every  serious  effort  must  be  made  to  main- 
tain or  improve  the  general  health.  Spite  of  the  languor 
characteristic  of  the  disease,  exercise  in  the  open  air  must 
be  resolutely  taken;  the  skin  must,  by  a  daily  warm  batli, 
be  induced  to  act  freely;  the  clothing  must  be  light  but 
warm,  flannel  being  worn  next  the  skin  to  guard  against 
any  sudden  chill,  and,  if  wealthy,  the  patient  must  not  be 
allowed  to  expose  himself  to  the  rigor  and  variations  of 
temperature  characteristic  of  a  Northern  winter.  As  a 
general  rule,  it  is  well  to  eliminate,  as  far  as  is  possible, 


TREATMENT    OF    DIABETES.  305 

starch  and  sugar  from  the  dietary.  This  last  precaution- 
ary measure  is  calculated  to  relieve  the  sufferer  from  the 
secondary  discomforts  attendant  on  the  presence  of  any  ex- 
cess of  unhurned  grape-sugar  in  the  blood  and  its  escape 
l)y  the  kidney.  Full  dietar}^  tables  may  be  obtained 
of  any  large  maker  of  specialties  for  diabetic  sufferers, 
though  the  remarks  on  the  success  of  such  dietetic  treat- 
ment, often  interpolated  by  them,  must  be  accepted  cum 
grano,  for,  as  a  matter  of  fact,  some  sufferers  retain  their 
general  health  better  on  the  ordinary  mixed  dietary,  or 
even  on  a  dietary  specially  rich  in  sugar,  than  on  one 
nearly  devoid  of  starch  and  sugar,  and  the  mere  disap- 
pearance or  modification  of  a  symptom — the  presence  of 
grape-sugar  in  urine — must  never  be  put  in  the  balance 
against  the  general  well-being  of  the  patient.  In  any 
case,  the  nutrition  of  the  patient  must,  if  everything  else 
has  to  stand  aside,  be  kept  up,  and  this,  be  it  remembered, 
may  on  a  rigid  anti-diabetic  regime  fail,  from  several 
causes,  amons;  which  mav  be  reckoned  distaste  for  the 
diet,  its  sameness  and  comparative  expense,  and  last,  but 
not  least,  the  miscalculation  and  consequent  misdirections 
of  the  manufacturers,  who  assume  that  all  their  foods  are 
easily  converted  to  bodily  nutriment,  when,  as  a  matter  of 
fact,  many  of  the  diabetic  articles,  such  as  bran  and  glu- 
ten, are,  as  compared  with  ordinary  wheaten  flour,  for 
which  they  are  recommended  as  substitutes,  but  indiffer- 
ently digested  and  absorbed. 

The  treatment  of  that  form  of  albuminuria  which  is 
traceable  to  liver  derano-ement  consists  in  takins;  much 
exercise  and  limiting  the  consumption  of  food  to  the 
needs  of  the  body. 

In  gall  stone,  again,  the  same  directions  are  all  that  can 
be  given.  The  general  health  must  be  improved,  and  all 
sources  of  worry  and  anxiety  be,  as  far  as  is  possible,  ban- 


306  DISEASES   DUE    TO    IMPERFECT    DIGESTION. 

islied.     During  the  passage  to  the  boAvel  of  one  of  these 
concretions  the  extreme  pain  usually,  but  not  invariably, 
produced,  must  be  alleviated  by  hot  external  applications 
and  by  opiates  internally.     The  vomiting  often  set  up  dur- 
ing this  stage  is  not  to  be  checked,  being  of  great  use  in 
assisting  onwards  the  passage  of  the  stone  and  relaxing 
the  muscular  spasm  of  the  tube  in  which  it  is  situated. 
AYhen  there  is  good  reason  to  believe  that  many  of  these 
stones  are  contained  in  the  gall-bladder,  an  operation  for 
their  removal  is  the  safest  and  best  course  to  recommend. 
Salicylic  acid,  from  its  power  of  increasing  the  watery 
constituents  of  the  bile,  has  been  recommended  as  a  pre- 
ventive of  gall-stone  formation.     It  is  unnecessary  to  say 
that  this  property  is  soon  lost,  and  the  liver  is  left  in  a 
worse  state  than  before  the  administration  of  the  drug. 
Nevertheless,  sometimes  for  a  few  daj^s,  when  the  presence 
of  grit  or  of  small  stone  in  the  minuter  tubules  of  the  liver 
is  suspected,  this  drug  may  be  given.     In  the  Appendix  I 
have  given  a  useful  formula  (No.ll)  for  its  administration. 
We  have  already,  in  Chapter  VIII.,  fully  dealt  with  the 
treatment  of  gout,  biliousness,  rheumatism,  and  obesity, 
all  of  which  may  result  from  a  simple  excess  of  food,  as 
well  as  from  the  failure  of  an  unusually  weak  liver  in  tho 
presence  of  ar  normal,  or  even  a  sub  -  normal,  supply  of 
nounshment. 

Most  commonly  of  all,  these  disorders  have  the  dual 
orio'in,  excess  of  food  plus  functional  failure,  and  the  cases 
are  often  rendered  more  chronic  and  more  difficult  of  cure 
by  the  accumulations  of  waste  in  the  system,  the  result 
of  deficient  muscular  exercise,  and  of  failing  excretory 


CHAPTEK  XI. 

DISEASES  DUE  TO  DEFECTS  IN   THE  ORGANS   OF  THE 

FOOD  SYSTE^L 

Sketch  of  Normal  Heart  Functions.  — Tlie  return-blood  from  the  body 
(tbe  venous  blood)  is  poured  into  the  right  side  of  the  heart, 
whence  it  is  pumped  through  the  lungs  (where  it  is  charged  with 
oxygen)  to  the  left  side  of  the  heart. 

It  enters  the  ventricle  (the  main  cavity)  of  the  left  side,  by  the  mi- 
tral orifice.  This  orifice  is  provided  with  valves,  the  mitral  valves, 
which  close  when  the  ventricle  contracts  to  force  the  blood-cur- 
rent on  to  the  tissues.  The  opening  by  which  blood  passes  on 
to  the  tissues  is  called  the  aortic  orifice,  and  it  is  also  provided 
with  valves,  the  aortic  wives,  which  prevent  the  regurgitation  of 
the  blood  into  the  ventricle  when  this  structure  dilates  to  take 
in  a  fresh  supply  of  blood. 

The  structure  of  the  right  side  of  the  heart  is  closely  similar  to  that 
of  the  left,  but  it  is  very  rarely  the  seat  of  disease. 

Sketch  of  the  Valvular  Diseases  of  the  Heart. 

(a)  When  the  mitral  orifice  is  contracted,  there  must,  therefore,  ensue: 
first,  a  slow  engorgement  (congestion)  of  the  lungs,  then  an 
engorgement  of  the  right  side  of  the  heart,  then  a  similar  state 
in  the  veins  all  over  the  body  (inducing  passive  congestion  of 
all  organs),  and  finally  dropsy. 

(i^)  When  the  mitral  valves  have  been  rendered  incompetent  by  dis- 
ease, the  same  backward  engorgement  will  take  place,  but  the 
process  will  be  a  slower  one.  There  will  also  be  some  increase 
in  size  of  the  left  ventricle. 


(c)  When  the  aortic  orifice  is  contracted,  there  will  be  great  enlarge- 

ment of  the  left  ventricle,  which  for  a  time  will  compensate 
for  the  obstruction.  To  this  will  succeed  a  bagging-out  and 
failure  to  contract  of  the  ventricle,  and  then  gradually  all  the 
secondary  consequences  of  mitral  disease.  There  will  be,  how- 
ever, in  advanced  stages,  some  risk  of  sudden  death  on  great 
exertion. 

(d)  When  the  aortic  valves  are  incompetent,  there  will  be  a  constant 
reflux  of  blood  from  the  aorta  and  embarrassment  of  the  left 
ventricle,  telling  back  gradually  on  the  right  side  of  the  heart 
and  on  the  whole  bod3^  In  advanced  stages  sudden  effort  may 
prove  fatal. 

The  diseases  of  the  orifices  or  valves  of  the  heart  are  due  to  a  puck- 
ering of  their  inner  linings,  the  result  of  inflammation  of  these 
linings,  such  as  is  of  common  occurrence  in  rheumatic  fever. 

Treatment. — Caution  as  to  great  exertion  and  a  maintenance  of  gen- 
eral health  often  prevent  the  occurrence  of  any  distressing  symp- 
toms in  heart  disease,  and  suffice  to  prolong  life  to  the  natural 
term. 

Other  less  common  forms  of  heart  disease  considered.    Arterial  and 

venous  diseases. 


XT  be   fOO^    Q^  stem— (continued). 


CHAPTER  XL 

DISEASES  DUE  TO  DEFECTS  IN  THE  ORGANS  OF 
THE  FOOD  SYSTEM. 

I.   DISORDERS  OF  THE  HEART,  ARTERIES,  AND  VEINS. 

The  following  is  a  list  of  these  food  organs,  with  their 
functions  : 

(a)  Concerned  in  the  reception  and  digestion  of  foods  : 
the  mouth,  stomach,  and  intestine,  with  each  their  glands. 

(b)  Concerned  in  secondary  digestion  :  the  portal  vein 
and  liver. 

(c)  Concerned  in  tertiary  digestion — ^.  e.,  the  final  desti- 
nation of  food  :  the  following  organs,  which  are  so  im- 
portant that  I  shall  italicize  them. 

(1)  The  heart  and  arteries,  in  the  distribution  of  food. 

(2)  The  cells  of  the  hody,  in  the  combustion  of  fuel- 
foods  (by  the  aid  of  oxj^gen)  and  the  metamorphosis  of 
albumen. 

(3)  The  lymphatic  i7iterspaces,  in  collecting  the  products 
of  combustion  and  metamorphosis  ;  the  lymphatic  pumps, 
of  which  the  principal  are  the  pleurae,  worked  by  the  move- 
ments of  respiration  ;  the  pericardium,  by  the  heart's  ac- 
tion ;  the  peritoneum,  by  the  intestinal  movements  ;  the 
synovial  membranes  of  joints,  by  the  movements  of  the 


310     DISORDERS    OF   THE    HEART    AND    BLOOD-VESSELS. 

limbs  ;  the  lymph  pumps  of  muscle-sheaths,  worked  by 
muscular  contraction  ;  all  concerned  in  moving  forward 
such  waste  material  along  the  lymphatic  ducts  and  through 
the  lymphatic  glands  towards  the  veins,  whence  it  is  ex- 
pelled the  body — the  water  and  carbonic  acid  by  the  lungs 
and  skin,  the  debris  from  cell  metamorphosis  by  the  kid- 
neys, and,  to  a  slight  extent,  by  the  liver. 

(4)  The  lungs,  concerned  in  the  oxygen  supply. 

(5)  Concerned  in  the  formation  or  perfection  of  new 
blood  corpuscles  are  certain  tissues  :  these  are  the  spleen, 
the  thyroid  and  thymus  glands,  the  supra-rencd  capsules, 
the  pituitary  and  pineal  glands  and  the  red  tnarrovo  of 
bones. 

The  above  long  list  of  organs  may,  consistently  with  the 
purposes  of  a  work  not  intended  to  deal  exhaustively  with 
physiology,  be  considerably  shortened. 

In  the  first  place,  we  have  already  sufficiently  discussed 
the  organs  concerned  in  primary  and  secondary  digestion, 
and  need  not,  therefore,  revert  to  them  ;  those  of  tertiary 
digestion  alone  concern  us,  and  will  be  dealt  with,  con- 
veniently, in  the  following  order  : 

I.  Disorders  of  the  Heart,  Arteries,  and  Veins. 
II.  Disorders  of  the  Blood. 

III.  Disorders  of  the  Blood-forming  Glands. 

IV.  Disorders  of  the  Lymphatics. 
V.  Disorders  of  the  Skin. 

VI.   Disorders  of  the  Kidneys. 
VII.  Disorders  of  the  Lungs. 

DISORDERS  OF  THE  HEART,  ARTERIES,  AND  VEINS. 

Among  the  disease  bogies  which  terrify  humanity,  the 
disorders  of  the  heart  hold  a  prominent  place. 

And  yet  this  place  is  a  usurped  one,  for  grave  heart 
failures  are  rare,  the   secondary  derangements  to  which 


STRUCTURE    AND    DUTIES    OF    THE    HEART.  311 

they  can  give  rise  are  easily  foretold,  and  often,  with  care, 
preventible  ;  while,  as  compared  with  sufferers  from  other 
organic  disorders,  the  victims  of  heart  disease  enjoy  a 
remarkably  prolonged  existence,  and  are  rarely,  except 
towards  the  end  of  their  tether,  inconvenienced  by,  or 
even  conscious  of,  the  existence  of  their  complaint. 

It  may  not  be  a  waste  of  space  to  ask  ourselves  the 
reason  why,  the  heart  being  without  question  the  most 
important  organ  of  the  whole  body — that  organ  on  whose 
perfect  action  depend  alike  the  movements  of  the  body 
.and  those  of  the  mind — it  can  reasonably  be  said  that  its 
derangements,  both  functional  and  organic,  are  often  but 
matters  of  secondary  importance.  The  answer  is  to  be 
found  in  a  study  of  the  structure  of  the  heart  and  the 
very  nniversality,  as  regards  the  body,  of  its  duties. 

The  heart  is,  first  of  all,  nothing  more  than  a  round 
muscl^,  capable,  like  all  muscles,  of  contracting  and  ex- 
panding ;  the  inrush  of  blood  supplying  the  stimulus, 
which,  acting  on  the  reflex-nerve  mechanism  situated  in 
its  substance,  determines  that  regular,  rhythmic  action 
with  which  we  are  all  familiar,  and  thus  maintains  an 
even  supply  of  blood  to  all  the  bodily  tissues. 

Internally,  the  heart,  is  divided  by  a  strong  muscular 
partition  into  two  distinct  halves,  called  the  right  and  the 
left.  The  right  side  receives  and  pumps  away  to  the 
lungs  the  venous  blood  which  returns  from  the  tissues, 
together  with  that  from  the  liver  ;  the  left  receives  the 
red  arterial  blood  on  its  return  from  the  lungs,  and  pumps 
it  away  to  the  body  at  large  to  nourish  the  tissues.  Each 
half  of  the  heart  is  furthermore  subdivided  into  the  fol- 
lowing two  divisions,  similar  on  both  sides  —  a  small  and 
weak  cavity  called  an  auricle,  which  receives  the  blood  and 
passes  it  on  to  a  larger  and  stronger  one  called  a  ventricle, 
which  does  the  work  of  pumping. 


312     DISORDERS    OF    THE    HEART    AND    BLOOD-VESSELS. 

The  ventricles  at  tlieir  points  of  intake  and  output  are 
provided  with  simple  valves,  those  at  the  inlet  opening 
with  the  inrush  of  blood  and  closing  as  the  ventricle  con- 
tracts ;  those  at  the  outlet  then  opening  and  closing  auto- 
matically by  the  pressure  of  the  blood  column  above  them, 
as  the  ventricle  again  dilates  to  take  in  more  blood. 

If  the  reader  will  think  of  the  action  of  an  ordinary 
rubber  enema,  which,  as  the  ball  dilates,  takes  in  water  by 
the  tube  coming  from  the  water-supply,  and  as  it  contracts 
forces  its  contents  onwards  by  the  outlet  tube,  Avhile  all 
backward  flow  is  checked  by  a  simple  valve,  he  will  ob- 
tain a  very  fair  idea  of  the  action  of  each  side  of  the 
heart.* 

All  the  cavities  of  the  heart  and  all  its  valves  are  lined 
by  a  smooth  membrane  (the  endocardium),  and  it  is  to  the 
inflammation  and  subsequent  contraction  of  this  mem- 
brane that  the  shrinking,  and  consequent  imperfection,  of 
the  valves  which  constitute  the  basis  of  90  per  cent,  of  the 
cases  of  heart  disease  are  due. 

Now,  the  muscles  of  the  body  are,  as  compared  with  other 
organs,  but  infrequently  the  seat  of  any  acute  destructive 
lesion,  and  rarely  fall  victims  but  to  one  form  of  degenera- 
tion, the  fatty  variety  ;  and  therefore  the  muscular  tissue 
of  the  heart,  though  it  may  temporarily,  like  other  muscles, 
lose  tone,  and  that  which  depends  upon  tone,  force  and 
regularity,  is  but  very  seldom  indeed  attacked  by  any  de- 
rangement which  can  permanently  and  seriously  impair  its 
structure  and  its  powers. 

Now,  we  have  already,  when  speaking  of  the  lymphatic 
system  in  general,  referred  to  the  serous  bag  (the  pericar- 

*  I  omit  a  description  of  the  somewhat  complex  structure  of  the 
heart  valves.  Their  function,  which  is  exceedingly  simple,  is  the 
great  fact  to  he  remembered,  and  I  therefore  limit  myself  to  that  one 
point. 


STRUCTUEE    AND    DUTIES    OF    THE    HEART.  313 

(Hum)  which  surroiinds  the  heart,  and  have  stated  that  it, 
like  the  pleune  and  the  synovial  membranes  of  joints,  is 
an  integral  part  of  the  lymphatic  system.  The  smooth 
internal  lining  of  the  heart  is  also,  like  those  membranes, 
a  portion  of  the  lymphatic  system  (it  contains  )io  blood- 
vessels), and  shares  therefore  in  all  the  disorders  of  the 
system  with  which  it  is  in  communion.  Now,  the  great 
acute  disorder  of  the  lymphatic  system  is,  without  doubt, 
rheumatic  fever,  and  therefore  this  disease,  affecting  as  it 
does  almost  exclusively  the  synovial  and  serous  membranes 
of  the  body,  is  2:>«r  excellence  the  great  producer  of  heart 
disease,  while,  next  in  order  as  a  prominent  cause,  stands 
its  very  close  relation,  gout.  Any  very  acute  blood  dis- 
order may,  however,  derange  the  lymphatic  system,  and 
through  it  both  the  joints  and  the  heart,  and  therefore 
any  fever,  but  most  prominently  scarlet  fever,  may  also 
become  the  starting-point  of  disease  in  the  heart  or  its 
valves. 

We  may  thus  say  that,  compared  with  other  organs, 
grave  disease  of  the  heart  is  rare,  and  that  when  it  occurs 
it  almost  invariably  is  a  sequence  of  rheumatic  fever,  or, 
much  less  frequently,  of  gout  or  scarlet  fever,  and  that  the 
lesion  is  situated  in  the  lining  membrane  of  the  heart,  the 
contraction  of  this  membrane,  following  on  the  inflamma- 
tory swelling  of  the  acute  stage  of  the  disease  which  acts 
as  causation,  producing  a  puckering  of  the  surface,  of  little 
importance  as  far  as  the  lining  of  the  heart  cavities  is 
concerned,  but  of  vast  importance  in  its  effect  on  the 
calibre  of  their  outlets,  which  it  lessens  (producing  what 
is  called  stenosis),  and  on  their  valves,  which  it  contracts 
and  renders  incompetent, 

Now,  the  one  great  general  and  necessary  result  of  either 
of  these  forms  of  disaster — and  it  is  one  which  the  reader 
should  bear  in  mind,  for  by  its  light  can  be  easily  read  all 
14 


314     DISORDERS    OF    THE    HEART    AND    BLOOD-VESSELS. 

the  multitudinous  consequences  of  heart  disease  —  is  im- 
pairment of  the  heart's  function  and  of  the  circulation  of 
blood. 

The  man,  therefore,  who  has,  as  a  result  of  disease,  shriv- 
elled heart-valves  or  contracted  heart-cavity  orifices,  finds 
himself  thus  placed  :  his  heart  has  lost  one  eighth,  one 
sixth,  one  quarter,  or  one  half,  as  the  case  may  be,  of  its 
former  complete  power.  It  can  still  do  work  perfectly, 
and  for  the  normal  period  of  life,  if  that  work  be  propor- 
tioned to  its  lessened  power  ;  but  if  an  efi*ort  be  made  to 
undertake  the  old  measure  of  effort  w^ith  the  lessened  meas- 
ure of  heart-power,  the  result  will  be  a  slow,  gradual,  but 
sure  loss  of  ground,  which  must  end,  ere  the  normal  span 
of  life  is  reached,  in  death,  the  result  of  heart  failure. 

It  is  not,  therefore,  the  actual  lesion,  the  valve  contrac- 
tion, w^hich  progresses,  for  that  remains  stationary,  but 
the  premature  death  is  due  to  the  lessened  pumping  power 
of  a  heart  crippled  by  valve  failure. 

Now,  the  mechanism  of  the  heart  is  so  simple,  and  the 
instruments  of  precision  by  which  its  power  may  be 
gauged  are  so  accurate,  that  it  requires,  on  the  part  of  a 
phj^sician,  only  ordinary  skill  to  be  able  to  prescribe,  with 
very  fair  exactness,  the  limits  of  daily  exertion  which  a 
damaged  heart  can  stand  consistently  with  a  normal  ex- 
pectation of  life.  How  comes  it,  tlierefore,  that  the  vast 
majority  of  patients  with  affected  hearts  rush  on  so  blind- 
ly and  heedlessly  to  a  certain  premature  extinction  of 
life? 

Firstly,  because  their  ordinary  guide  to  disease,  pain, 
is,  in  heart  disease  as  in  consumption,  absent;  both  the 
heart  and  the  lungs  being  endow^ed  but  poorly  with  sensi- 
tive nerves.  Patients  are  therefore  loath  to  believe  in  the 
existence  of  grave  and  progressive  miscliief.  But  we  may 
ask:  Does  not  the  failure  of  the  circulation  induce  symp- 


THE  PEOGRESS  OF  DEAKT  FAILURE.        315 

toms  wliich  must  force  from  such  persons  a  due  recogni- 
tion of  the  gravity  of  their  case  ?  No,  for  the  breakdown 
is  gradual,  and  the  human  body  re-establishes,  in  the  way 
about  to  be  described,  an  equilibrium,  albeit  a  more  and 
more  unstable  one,  to  meet  each  point  of  failure.  In  the 
first  place,  the  cells  of  the  heart  possess,  like  all  living 
cells,  a  residue  of  vitality,  by  virtue  of  which  they,  for 
a  certain  number  of  years,  keep  the  heart  intact  and  in 
action  under  the  ordinary  conditions  of  life;  but  extraor- 
dinary conditions  are  now  present,  the  reserves  of  vitality 
are,  in  consequence,  called  up;  the  now  overworked  heart 
grows  and  thickens,  and  the  increased  muscular  power, 
the  result  thereof,  enables  the  circulation  for  a  time  to  be 
maintained  at  the  normal.  But,  sooner  or  later,  the  error 
of  this  spendthrift  policy  becomes  apjoarent;  the  reserves 
become  exhausted,  the  recuperative  power  of  the  heart 
falls  below  the  demands  made  on  it,  the  circulation  slack- 
ens, the  arteries  are  no  longer  sufficiently  filled,  and  the 
veins  become  gorged;  the  lymphatic  system,  which  eventu- 
ally empties  itself  into  the  veins,  shares,  of  necessity,  in  the 
engorgement,  and  the  lymph  escapes  freely  into  the  peri- 
toneum, into  the  pleurae,  into  the  pericardium,  and  into  all 
the  tissues  of  the  body,  making  its  appearance  first  in  the 
most  dependent  parts,  the  feet  and  legs,  and  thence,  un- 
less the  strain  be  taken  off  the  heart,  gradually  rising.  In 
one  word,  we  have  the  condition  known  as  general  dropsy. 
And  now  the  patient,  perforce,  must  rest.  Quietly  ly- 
ing in  bed  he  learns  a  lesson,  which,  taken  to  heart  in 
time,  would  have  saved  his  life,  for  he  sees  that,  the  strain 
involved  in  bodily  exertion  once  taken  off  the  laboring 
heart,  the  circulation  becomes  normal,  the  dropsy  recedes, 
and  the  sodden  internal  organs  become  once  more  dry  and 
perform  their  duties;  his  appetite  and  breathing  power 
be^i'in  once  more  to  be  healthv. 


316      DISOKDERS    OF    THE    HEAKT    AND    BLOOD-VESSELS. 

Again  Nature  bids  him  choose,  but  her  terms  are  now 
much  harder.  Will  he  live  for  a  few  years  a  life  of  inac- 
tion, or  will  he,  by  a  return  to  exertion,  court  a  speedy 
and  a  worse  return  of  dropsy  in  a  few  days,  weeks,  or 
months  ? 

If  he  choose  the  latter,  the  second  attack  of  dropsy  will 
be  more  intractable  that  the  first.  More  prolonged  and 
more  complete  rest  will  probably  result  yet  once  more  in 
a  temporary  recovery  of  the  circulation,  but  the  succeed- 
ing interval  of  health  will  be  brief,  and  before  long  yet  a 
third,  and  this  time  a  probably  fatal,  return  of  dropsy  will 
be  on  him. 

Such  is,  in  a  few  words,  the  course  of,  and  such  the  les- 
sons to  be  learned  from,  one  of  the  most  common  of  all 
valvular  lesions  of  the  heart,  mitral-valve  incompetence, 
the  result  of  imperfect  closure  of  the  valve  which  inter- 
venes between  the  left  auricle  and  the  left  ventricle  of  the 
heart. 

Let  us  now  discuss,  a  little  more  systematically,  the 
special  consequences  of  each  valve  lesion. 

The  heart  consists,  as  we  know,  of  two  similar  parts,  a 
right  and  a  left  jDortion. 

The  disorders  of  the  right  side  will  not,  however,  re- 
quire any  attention  at  our  hands,  for,  with  the  exception  of 
dilatation  of  the  right  ventricle,  which  is,  moreover,  in 
nearly  every  case  a  direct  consequent  of  pre-existing  dis- 
ease of  the  left  side  of  the  heart,  and  not,  therefore,  en- 
titled to  rank  as  a  primary  heart  malady,  disease  of  the 
right  side  of  the  heart  is  so  exceedingly  rare  as  to  consti- 
tute, when  present,  a  medical  curiosity. 

We  therefore  can  restrict  ourselves  to  the  disorders  of 
the  left  side  and  the  consequences  which  each  of  them,  re- 
spectively, will  entail.  The  annexed  simple  diagram  will 
assist  in  making  the  sequence  clear. 


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318       DISOEDERS    OF    THE    HEART    AND    BLOOD-VESSELS. 

Confining  ourselves,  then,  exclusively  to  the  left  side 
only  of  the  heart,  we  see  that  it  has  two  sets  of  valves — 
the  mitral  valve  (marked  31)  which  opens  to  let  the  bright- 
red  arterial  blood  from  the  lungs  run  into  the  ventricle, 
and  which  closes  when  this  ventricle  contracts  and  forces 
its  blood  contents  to  the  tissues  ;  and  the  aortic  valve 
^  (marked  A),  which  remains  closed  while  the  ventricle  fills, 
and,  yielding  to  pressure,  opens  when  the  ventricle  con- 
tracts to  force  its  contents  onward  to  the  tissues. 

But,  as  the  result  of  rheumatic  fever,  gout,  etc.,  two  ab- 
normal conditions  may  occur  at  either  orifice  ;  either  the 
opening  may  be  contracted  (this  is  called  stenosis  of  the 
mitral  or  the  aortic  orifice,  as  the  case  may  be),  or  the 
valves  may  be  so  shrunk  as  to  fail  to  meet  when  they 
should  close  (this  is  called  incomj^etence  of  the  mitral  or 
aortic  valve,  according  to  the  situation). 

Stenosis  (Contraction)  of  the  Mitral  Orifice. 

This  condition  must,  in  exact  proportion  to  its  extent, 
retard  the  current  of  blood  from  the  lung,  and  hence  de- 
lay its  passage  through  the  lung,  and  will  therefore  pro- 
duce, as  a  first  result,  constant  congestion  of  the  lungs, 
.  varying  in  degree  with  the  calls  made  on  the  heart  by 
exertion  and  the  amount  of  orifice  contraction  present. 
There  will,  therefore,  be  hreathlessness,  esj^ecially  on  exer- 
tion. The  next  inevitable  consequence  will  be  over-fulness, 
engorgement^  of  the  right  ventricle,  and  then  a  similar  state 
of  matters  in  the  right  auricle,  this  in  its  turn  producing 
a  distension  of  the  large  channel  that  feeds  it  and  that 
brings  the  venous  blood  and  the  lyniph  from  all  j^arts  of 
the  blood.  Thus  the  venous  circulation  will  be  slowed, 
and,  to  relieve  it,  forced  by  the  pressure  on  them,  the 
small  veins  and  lymphatics  will  allow  their  thinnest  fluid 
contents,  the  blood  serum,  to   exude  among  the  tissues ; 


STENOSIS    OF    THE    MITRAL    ORIFICE.  319 

thus  dropsr/,  commencing  where  the  current  is  weakest,  in 
the  most  dependent  parts,  i.  e.^  the  feet  and  legs,  will  aj:)- 
pear,  and  will  gradually  advance,  distending  with  fluid  those 
large  lymph  cavities,  the  peritoneum  (producing  hydro- 
peritoneum),  the  pleurae  (producing  hydro-thorax),  and  the 
pericardium  (producing  hydro-jjericardiinn),  which  state  of 
matters  will,  if  it  be  permitted  to  progress,  rapidly  end 
in  a  mechanical  and  final  arrest  of  the  heart  and  lungs. 

The  only  rational  treatment  is  rest,  and  temporary  im- 
provement of  the  heart's  tone  by  such  suitable  food  as  can 
be  digested.  It  is  evident  that  no  drug  can  avail  to  abate, 
much  less  to  permanently  rectify,  this  vicious  circle  of 
disorder.  It  is  folly,  in  the  absence  of  complete  rest,  to 
administer  a  cardiac  stimulant,  even  as  a  temporary  pal- 
liative;  it  is  worse  than  folly,  in  the  possession  of  even 
elementary  anatomical  knowledge,  to  pretend  to  a  cure  by 
means  of  it. 

Much  can,  however,  be  achieved  by  timely  and  judi- 
cious  advice,  for,  in  at  least  the  vast  majority  of  instances, 
the  progress  of  events  extends,  ere  the  final  stages  of  gen- 
eral dropsy  are  reached,  over  many  years,  and  this  inter- 
val of  fair  health  may  be  doubled  or  trebled  by  the  careful 
avoidance  of  undue  exertion;  the  general  health,  upon 
which  the  tone  of  all  muscles,  and  therefore  of  the  heart, 
depends,  being  carefully,  by  means  of  a  well-ordered  life, 
maintained  at  its  best. 

Stenosis  of  the  mitral  valve  may,  when  of  many  years' 
standing,  and  when  the  heart's  action  is  much  embarrassed, 
lead,  after  violent  exertion,  to  sudden  death,  but  such  a 
termination,  compared  with  a  gradual  extinction  of  life 
by  dropsical  effusion,  is  rare. 

Incompetence  of  the  Mitral  Valves. 
In  the  case  of  mitral  stenosis  just  considered,  the  auricle 


320       DISORDERS    OF    THE    HEART    AND    BLOOD-VESSELS. 

could  not,  owing  to  the  contraction  of  the  auriciilo-ven- 
tricular  opening,  empty  itself,  and  fill  the  ventricle  in 
proper  time;  in  mitral  incompetence,  which  we  are  now 
studying,  the  ventricle  is  easily  and  completely  filled,  but 
on  contraction  not  only  forces  the  blood  on  by  that  great 
channel,  the  aorta,  to  the  body  in  general,  but  also,  since 
the  mitral  valves  do  not  meet,  forces  some  blood  back  into 
the  auricle,  keeping  this  latter  cavity,  as  in  mitral  steno- 
sis, always  overfilled  w^ith  blood. 

And  this  engorgement  of  the  auricle  leads,  as  in  mitral 
stenosis,  first  to  congestion  of  lungs,  then  to  surcharge  of 
the  right  side  of  the  heart,  then  tells  backward  on  the 
general  venous  and  lymphatic  circulation,  and  ends  neces- 
sarily in  general  dropsg. 

Thus  the  secondary  consequences  of  mitral  stenosis  and 
of  mitral  incompetence  run  on  precisely  the  same  lines, 
but  the  results  of  mitral  incompetence  are  not  so  quickly 
seen,  inasmuch  as  the  embarrassment  of  the  heart  is  less, 
and  therefore  the  disease  itself  is  not  of  equal  gravity  to 
mitral  stenosis;  indeed,  many  people  are  through  a  long 
life  never  inconvenienced  by  the  presence  of  this  lesion, 
which,  moreover,  even  in  the  worst  cases,  scarcely  ever  can 
lead  to  sudden  death. 

The  treatmerd  consists,  as  before,  in  the  maintenance  of 
the  general  health  and  the  exercise  of  caution  as  regards 
exertion. 

Sometimes,  indeed,  towards  the  end  of  heart  failure, 
when  the  laboring  left  ventricle  of  the  heart  (thickened 
at  first,  but  subsequently  dilated)  shows,  by  the  hesitancy 
and  irregularity  of  its  contraction,  the  extreme  difficulties 
under  which  its  ever  imperfect  functions  are  performed,  a 
heart  stimulant,  such  as  digitalis,  strophanthus  hispidus, 
or  convallaria  majalis,  may,  to  recall  more  rapidly  than 
can  rest  alone,  the  normal  tone  and  rhj^thm  of  the  heart, 


STENOSIS    OP    THE    AORTIC    ORIFICE.  321 

be  had  recourse  to.  But,  beyond  the  very  temporary  res- 
toration of  regularity  of  action,  no  benefit  that  cannot  be 
more  safely  and  more  permanently  obtained  from  com- 
plete rest  is  thereby  secured. 

Let  us  now  turn  our  attention  to  the  aortic  opening- 
(marked  A  on  the  diagram),  and  study  the  similar  condi- 
tions of  stenosis  and  valvular  incoraj^etency  as  occurring 

there. 

Stenosis  (Contraction)  of  the  Aortic  Orifice  • 

(marked  A  on  diagram). 

Any  narrowing  of  this  outlet  must  render  the  complete 
emptying  of  the  left  ventricle  a  matter  of  greater  difficulty 
than  it  is  in  a  normal  state. 

This  increased  demand  for  muscular  power  on  the  part 
of  the  left  ventricle  leads  to  a  thickening  of  its  muscular 
walls,  and  therefore  to  a  more  powerful  contraction;  this 
is  called  the  stage  of  compensation,  that  in  which  the  in- 
creasing muscular  power  keeps  pace  with  the  obstructive 
difficulties. 

During  the  stage  of  compensation,  beyond  the  sense  of 
a  powerfully  acting  heart,  the  sufferer  experiences  no  dis- 
comfort, for  the  heart  is  performing  its  full  duties.  But 
the  reserve  force  of  the  muscular  cells  in  the  heart  wall 
are  all  the  time  being  freely  called  up,  and  the  day  of 
bankruptcy  must  and  does  arrive,  the  stricture  of  the  ori- 
fice remaining  in  statu  qiio,  while  the  muscular  power  of 
the  heart  is  breaking  down.  The  ventricle  can  now  no 
longer  at  each  beat  perfectly  empty  itself,  the  blood  cur- 
rent to  the  body  gets  smaller  and  smaller,  while  the  ven- 
tricle bulges,  and  the  auricle,  the  lungs,  the  right  heart, 
and  the  veins  and  lymphatics  of  the  body  become  each, 
in  due  backward  order,  engorged.  Thus,  in  the  majority 
of  cases,  dropsy  closes  the  scene,  as  in  failures  at  the 
mitral  orifice;  but  sudden  death,  the  result  of  some  un- 
14* 


322       DISORDERS    OF    THE    HEART   AND    BLOOD-VESSELS. 

usual  demand  made  on  the  heart  when  the  compensation 
stage  has  passed,  is  very  common. 

The  treatment  is  the  same  as  in  mitral  stenosis  and 
mitral-valve  incompetency — namely,  wise  economy  of  the 
enfeebled  heart  powers  and  attention  to  the  general 
health.  Heart  stimulants  ma}^,  towards  the  end,  be  em- 
ployed to  tide  over  moments  of  extreme  danger  from 
heart  failure,  but  the  wisdom  of  such  a  course  is  very 
doubtful. 

Incompetence  of  the  Aortic  Valve. 

In  this  case  there  is,  owing  to  the  patency  of  the  orifice, 
the  result  of  imperfect  closure  of  its  valves,  a  regurgita- 
tion of  blood  back  into  the  ventricle  from  the  aorta. 

This  produces  overloading  of  the  ventricle,  and  leads, 
as  in  the  case  of  aortic  stenosis,  to  thickening  of  the  ven- 
tricular muscular  walls,  to  cope  with  this  symptom.  Here 
we  have  again  a  first  stage,  often  lasting  for  many  years, 
of  compensation^  marked  by  no  disagreeable  evidences  of 
disease. 

To  this,  at  length,  succeeds  failure  of  compensation  and 
the.  various  backward  engorgements,  ending  in  dropsj% 
which  we  have  already  studied. 

In  both  aortic  stenosis  and  incompetence  of  the  aortic 
valves,  the  defective  arterial  supply  leads,  as  compensa- 
tion fails,  to  falntness,  giddiness,  and  defective  vision  on 
exertio7i  due  to  an  imperfect  arterial  blood  supply  to  the 
brain. 

In  both  diseases,  while  a  gradual  death  by  dropsy  is  the 
more  common  issue,  sudden  death  is  not  infrequent. 

The  treatment  is  the  same  in  both  disorders. 

To  sum  up :  In  all  disease  at  tlie  orifices  of  the  two  cavi- 
ties of  the  left  side  of  the  heart  (and  such  are  90  per  cent. 


VALVULAR    DISEASES    OF    THE    HEART.  323 

of  all  cases  of  heart  disease),  the  following  truths  must  be 
borne  in  mind: 

There  is  no  local  pain. 

There  are,  in  the  early  stages,  usually  no  general  symp- 
toms of  discomfort. 

In  the  later  stages,  shortness  of  breath,  due  to  engorge- 
ment of  the  lung,  is  an  early  sign,  and  this  is  succeeded 
by  venous  congestion  of  the  organs  of  the  body,  and 
therefore  mainly  by  dyspepsia  and  liver  derangement, 
which  precede,  often  by  months  or  years,  the  actual  and 
visible  dropsy  of  the  tissues  of  the  feet  and  legs. 

Sudden  death  is  a  rare  termination  of  lesions  at  the 
mitral  orifice,  but  a  fairly  common  one  of  those  at  the 
aortic  opening. 

The  treatment  by  rest,  if  commenced  in  time,  will  often 
suflice  to  altogether  prevent  premature  death  from  heart 
failure,  and  alw^ays  markedly  to  prolong  life.  At  every 
stage,  in  rest  and  a  regular  mode  of  life  consists  the  sole 
treatment.  Heart  stimulants  are  only  needed  in  great 
emergency;  and  the  reaction  which,  of  necessity,  follows 
their  use  tends  in  most  cases  actually  to  shorten  life. 

The  rare  diseases  of  the  orifices  of  the  right  side  of  the 
heart  lead,  as  those  w^ho  have  followed  me  must  clearly 
see,  even  more  rapidly  than  do  those  of  the  left  side,  to 
engorgement  of  the  lungs  and  of  the  whole  venous  sys- 
tem, and  to  general  dropsy. 

Let  us  now  briefly  review  those  few,  and,  from  their 
rarity,  almost  unimportant,  heart  failures,  not  the  se- 
quences of  an  inflammation  of  the  lining  membrane  of 
the  heart,  and  a  consequent  shrinking  of  the  valves,  or  of 
the  apertures,  of  heart  cavities. 


324       DISORDERS    OF    THE    HEART    AND    BLOOD-VESSELS. 

Malformation  (Congenital)  of  the  Heart. 

Most  people  at  the  present  day  are  aware  that  each  hu- 
man being,  during  the  intra-maternal  portion  of  its  exist- 
ence, passes  through  a  course  of  development,  each  stage 
of  which  is  fairly  representative  of  one  of  the  lower  orders 
of  animal  structure.  As  regards  the  organ  now  in  ques- 
tion, the  heart,  it  is  in  the  human  embryo  at  first  absent, 
as  in  the  protozoa;  then  consists  of  but  one  cavity,  as  in 
the  crustaceans  ;  then  of  two,  as  in  the  fishes  ;  then  of 
three,  as  in  the  reptiles;  and  finally  of  four,  as  in  the  birds 
and  mammals. 

Sometimes,  from  causes  interfering  with  the  maternal 
circulation,  this  development  is  arrested,  and  the  infant  is 
born  witli  but  a  two-chambered  heart.  This  is  exceeding- 
ly rare,  but  an  infant  with  a  three-chambered,  a  reptilian, 
heart,  is  a  fairly  common  phenomenon. 

When  such  malformation  has  occurred  there  is  no  diffi- 
culty attending  its  instant  recognition,  for,  w^hen  the 
arterial  and  venous  blood-cavities  communicate,  all  the 
blood  pumped  to  the  tissues  must,  in  place  of  being  scar- 
let, be  of  a  purple  hue  and  impart  that  color  to  the  skin. 
The  infant  is  therefore  blue.  The  blood  will  also,  like  that 
of  the  reptiles,  be  of  low  temperature,  and  the  body  will 
therefore  be  cold. 

Such  children,  unfitted  as  they  are  to  exist  under  th% 
ordinary  conditions  of  human  life,  die  in  the  course  of  a 
few  hours,  days,  or  months.  In  rare  cases,  and  where  the 
malformation  has  been  but  slight,  twenty  years  of  life,  or 
even  more,  have  been  reached. 

Inflammation  of  the  Muscular  Substance  of  the  Heart. 

Except  as  a  very  rare  sequence  of  general  blood-poison- 
ing, inflammation  of  the  muscular  substance  of  the  heart 
is  scarcely  known. 


INFLAINIMATIONS    OF    THE    HEART.  325 

Sometimes,  howevei-,  in  rheumatic  fever,  inflammation 
of  the  inner  lining  membrane  of  the  heart  (the  endocar- 
dium), or  of  the  bag  which  encloses  the  heart  (the  j^ericar- 
dium),  may  extend  to  the  substance  of  the  heart  itself, 
but  such  secondary  inflammation  is  uncommon.  When 
it  occurs  it  ends  almost  uniformly  in  death  by  heart 
rupture. 

Inflammation  of  the  Inner  and  Outer  Linings  of  the  Heart. 

This  is  the  very  common  sequence  of  rheumatic  fever, 
or  indeed  of  any  severe  disorder  affecting  the  lymphatic 
system,  with  which  the  linings  of  the  heart  are  in  direct 
communion,  and  indeed  of  which  they  form  an  integral 
part. 

(a)  Inflammation  of  the  inner  lining,  the  so-called  endo- 
cardium, occurs  in  more  than  half  the  cases  of  rheumatic 
fever.  Sometimes  it  is  slight  and  leaves  no  embarrassing 
contraction  behind,  at  other  times  it  is  more  severe  and 
leads  to  one  or  more  contractions  of  the  apertures  of  the 
heart  cavities  or  of  their  valves.  The  consequences  of 
both  of  these  circulatory  impediments  we  have  already 
discussed. 

{b)  Inflammation  of  the  outer  lining,  the  so-called pericar- 
diwn.  The  pericardium  is  the  lymph  sac,  in  a  reduplica- 
tion of  which  the  heart  rests. 

Any  acute  disorder  of  the  general  lymphatic  system, 
and  rheumatic  fever  is  the  almost  sole  example  of  such 
derangement,  may  lead  to  inflammation  of  the  pericardi- 
um, followed  usually  by  the  effusion  into  it  of  a  large  sur- 
plus amount  of  fluid. 

The  result  of  such  pericardial  distension  is  to  push  the 
heart  upwards,  and,  by  compressing  it,  to  impair  or  even 
to  arrest  its  movements. 

The  treatment  consists  in  proportioning,  by  means  of 


326       DISORDERS    OF   THE    HEART    AND    BLOOD-VESSELS. 

absolute  rest,  the  decreased  heart  functions  to  a  minimum 
of  exertion,  and  if,  in  spite  of  such  measures,  the  fluid 
still  rises  and  the  embarrassment  of  the  heart  becomes 
greater,  to  tap  the  pericardium. 

The  outlook  in  this  form  of  inflammation,  technically 
called  Pericarditis,  is  always  grave.  Perfect  recovery  oc- 
curs in  about  60  per  cent,  of  all  cases;  imperfect  recovery, 
the  surfaces  of  the  pericardium  remaining  permanently 
glued  together,  in  about  30  per  cent.,  death  resulting  in 
about  10  per  cent.  Concurrent  disease  of  the  heart  or  of 
other  severe  disease,  such  as  Bi'ighfs  disease  or  diabetes, 
renders  the  prognosis  always  very  serious. 

Degenerations  of  the  Heart. 

{a)  Fatty  Degeneration. — This  consists  in  a  gradual 
metamorphosis  of  the  muscular  fibres  of  the  heart  into 
fat,  the  result  of  disease  of  the  small  arteries  which  feed 
the  heart  muscle,  or  of  a  general  failure  of  nutrition,  such 
as  is  seen  in  diphtheria,  typhoid  fever,  etc. 

The  symptoms  are  iceak  action  of  the  heart,  with  short- 
ness of  breath,  and  sometimes  with  signs  of  general  dropsy. 

The  prognosis  is  always  grave,  but,  since  the  diagnosis 
is  difficult  and  never  absolutely  certain,  need  not  be  hope- 
less. 

Treatment  consists  in  rest  and  in  the  adoption  of  meas- 
ures calculated  to  improve  the  health. 

N.  B. — It  is  very  necessary  not  to  confound  fatty  de- 
generation of  the  heart,  occurring  always  in  the  feeble, 
and  nearly  always  in  the  meagre,  with  fatty  depositions 
on  the  heart,  a  mere  agglomeration  of  adipose  material  on 
that  organ,  to  which  the  obese  are  subject.  In  the  for- 
mer disease  the  heart  is  apt  to  rupture  on  exertion,  in  the 
latter  to  stop  by  reason  of  the  superincumbent  deposits  of 
fat. 


DEGENERATIONS    OF    THE    HEART.  327 

Hie  treatment  of  fatty  degeneration  is  rest,  that  of  fatty 
deposition  consists  in  a  reduction  of  the  obesity,  and  in 
the  improvement  of  muscular  tone,  by  cautious  exercise. 

(h)  Cancerous  Degeneration.  —  Cancer  may  attack  the 
heart,  but  this  site  of  cancer  is  a  rare  one. 

(c)  Enlargement,  Dilatation,  and  Misplacement  of  the 
Heart. — These  we  have  studied  in  connection  with  their 
almost  sole  causes,  disorders  of  the  orifices  of  the  aper- 
tures of  heart  cavities  and  derangements  of  the  pericar- 
dium. 

All  three  may,  however,  occasionally  be  secondary  to 
other  disorders.  The  muscular  enlargement  may  be  due 
to  advancing  kidney  mischief  (gouty  kidney),  or  to  over- 
exertion, as  seen  sometimes  in  athletes;  the  dilatation,  to 
failure  of  general  health;  the  misj^lacement,  to  tumors  in 
the  chest  or  to  pleurisy. 

Ere  we  quit,  with  a  few  remarks  on  its  functional  de- 
rangements, the  subject  of  the  heart,  we  must  refer  to  one 
cardiac  disorder,  or  rather  one  symptom.  Angina  pectoris, 
which  may  depend  upon  either  severe  and  dangerous  or- 
ganic disease  of  this  organ  or  upon  some  transient  and 
purely  functional  derangement. 

Angina  pectoris,  or  hreast-pang^  is,  as  its  name  implies, 
a  symptom  only,  and  we  shall  discuss  it  as  such. 

It  is  characterized  by  the  sudden  occurrence  of  usually 
mteyise  pain,  which  darts  from  the  region  of  the  heart  to  the 
left  side  of  the  head  or  doAvn  the  left  arm,  and  is  accom- 
panied by  a  feeling  of  svffocatioyi  and  a  sense  of  impend- 
ing death.  The  attack  may  last  for  a  few  seconds  or  for 
hours,  generally  the  former,  and  usually  recurs  at  uncer- 
tain intervals. 

The  treatment  consists  in  an  active  search  for  the  un- 
derlying cause,  and  its  removal  when  possible. 

Angina  pectoris  is  rare  under  fifty  years  of  age,  and  is 


328       DISORDERS    OF   THE    HEART   AND    BLOOD-VESSELS. 

commoner  in  males  than  in  females.  The  actual  seats  of 
pain  are  the  nerves  of  the  heart  and  of  its  large  vessel,  the 
aorta,  and  this  pain  may  be  due  to  the  circulation  of  some 
poison,  notably  gout  poison,  in  the  blood,  producing  a 
neuralgia,  or  may  depend  upon  a  failure  of  the  blood  sup- 
l^ly  to  the  heart  muscle,  due  to  degeneration  of  the  arte- 
ries. In  the  former  class  of  cases  the  outlook  is  hopeful, 
in  the  latter  almost  hopeless. 

Tlie  attack  may  usually  be  cut  short  by  the  inhalation 
of  nitrite  of  amyl,  which  may  be  carried  about  in  glass 
capsules,  each  of  which,  when  broken,  liberates  a  fair  dose 
for  inhalation  of  this  drug.  If  this  fails,  full  doses  of 
alcohol  in  very  hot  water  should  be  administered. 

Functional  Derangements  of  the  Heart. 

Grave  diseases  of  the  body,  whether  of  the  lungs,  heart, 
liver,  or  of  any  other  organ,  if  unattended  by  the  symp- 
tom of  localized  and  acute  pain,  fail  often,  in  spite  of  the 
physician's  most  serious  expressed  forebodings  and  warn- 
ings, to  impress  the  patient's  mind  with  a  due  sense  of 
their  importance,  simply  because  the  impairment  of  func- 
tion to  which  they  give  rise  is,  at  first,  so  trivial,  and  in- 
creases so  gradually,  as  to  escape  notice,  and  because  the 
disease  is  local,  as  far  as  any  disease  of  the  human  body 
can  truthfully  be  called  so. 

Functional  disorder,  on  the  other  hand,  is  the  expres- 
sion in  one,  the  weakest,  part  of  the  body,  of  a  general 
derangement  of  health,  and  therefore  appeals  from  a  thou- 
sand sides  to  the  subject  of  it,  and,  very  early  in  its  course, 
raises,  in  the  mind,  great,  and  often  unfounded,  alarm. 

For  these  reasons  sufferers  from  fancied  disease  of  the 
heart  outnumber,  as  a  hundred  to  one,  the  subjects  of  gen- 
uine cardiac  mischief. 

It  is  amusing  to  note  the  number  of  fragile  mortals  who 


FUNCTIOXAL    DERANGEMENTS    OF    THE    HEART.  329 

suffer  from  a  weak  heart,  and  wlio  desire  that  tliis  organ 
should  be  speedily  strengthened.  They  are  like  children 
crying  for  loaded  rifles.  Wliat  havoc  indeed  a  strong 
heart,  their  ideal  heart,  would  play  in  their  feeble  body  ! 
Their  heart  may  indeed,  as  compared  with  that  of  a  robust 
youth,  be  justly  regarded  as  weak  and  feeble  in  action, 
but  it  is  in  exact  keeping  with  the  needs  and  general  con- 
dition of  their  body — the  only  test  of  a  perfect  heart.  If 
they  choose  to  improve  the  tone  of  the  general  muscular 
system,  the  heart  will  keep  pace  with  such  improvement. 
The  only  weak  heart  that  is  a  danger,  that  requires  any 
form  of  treatment  directed  specially  to  its  state,  is  the 
very  rarely  found  heart  that  is  undergoing  fatty  degener- 
ation, that  lags  hopelessly  behind  even  when  the  bodily 
demands  made  on  it  are  at  their  lowest. 

In  dealing  with  atony  of  the  stomach  and  intestine  I 
showed  the  fallacy  of  endeavoring  to  whip  up  temporarily 
and  exclusively  one  debilitated  organ,  and  proved  that 
the  only  end  gained  could  be  to  force  out  of  that  general 
equilibrium  of  bodily  organs  that  exists  even  in  debili- 
tated states  the  organ  selected  for  stimulation.  The  true 
line  of  treatment  is  evidently  to  try  and  raise,  by  hygienic 
measures,  each  and  every  bodily  organ  simultaneously,  to 
establish,  in  short,  an  equilibrium  of  strengthened  organs. 

The  weak  heart,  therefore,  is  not  entitled  to  rank  even 
as  one  of  those  functional  cardiac  derangements  which  we 
must  now  discuss. 

Palpitation. — This  term  is  held  to  include  all  attacks  of 
violent,  rapid,  and  sometimes  irregular  action  of  the  heart,  at- 
tended often  by  feelings  of  tightness  in  the  chest,  shortness 
of  breath,  faintness,  and  fear  of  impending  death — a  group 
of  symptoms  with  which,  to  a  greater  or  less  extent,  we 
have  all  been  at  one  or  other  period  of  our  lives  familiar. 

Palpitation  is  but  very  rarely  a  symptom  of  disease  of 


330      DISORDERS    OF    THE    HEART    AND    BLOOD-VESSELS. 

the  heart.  This  statement  may  appear  so  incredible  that 
I  will  quote  verbatim  from  a  private  proof-sheet  of  lect- 
ures issued  by  the  present  distinguished  Professor  of 
Medicine  in  the  University  of  Edinburgh:  "Causes  of 
palpitation:  Morbid  irritability;  peripheral  or  central  irri- 
tation of  nerves;  altered  states  of  the  blood  (gout,  etc.); 
the  use  of  various  articles  of  diet  or  luxury,  and  certain 
mechanical  conditions." 

The  above  list  of  causations  may  appear  to  lay  readers 
a  little  technical,  but  to  the  sufferer  from  palpitation  it 
will  be  at  least  reassuring  to  know  that  heart  disease 
ranks  so  low  as  an  assent  in  this  disorder  as  to  be  deemed 
unworthy  of  notice,  unless,  indeed,  it  find  a  place  under 
the  heading  of  mechanical  conditions. 

Treatment  can  only  be  applied  when  the  special  cause, 
which  lies  outside  the  heart  itself,  has  been  traced  home. 

If  the  disorder  be  dependent  on  a  blood  poison,  which 
generally  will  be  found  to  be  either  uric  acid  (gout  poi- 
son) or  lead,  the  line  of  treatment  resolves  itself  into  the 
special  means  for  eliminating  such  abnormal  ingredient 
from  the  blood-stream.  If  the  blood  be  not  the  seat  of 
the  enemy,  the  nervous  system  may  be  justly  suspected, 
and  in  the  excessive  use  of  tobacco,  in  great  mental  anx- 
iety, prolonged  brain-work,  or  in  nervous  debilit}^  the  re- 
sult of  antemia,  may  the  cause  often  be  found. 

If  in  these  two  departments  our  search  is  baffled,  we 
turn  to  the  other  organs  of  the  body,  especially  to  the 
stomach,  liver,  intestine,  and  kidneys  (in  females,  to  the 
womb  and  ovaries),  for  indications  in  them  of  disorders 
that  can  tell  reflexly  upon  the  heart,  and  our  treatment 
will  depend  upon  our  discoveries.  In  no  case  is  the  heart 
to  be  treated,  for,  again  I  repeat  it,  the  malady  is  not 
located,  but  only  manifested^  in  that  organ. 

But,  the  reader  may  ask,  how  is   he,  without  special 


THE    DIAGNOSIS    OF    HEART    DISEASE.  331 

anatomical  knowledge,  to  make  the  necessary  investiga- 
tions? In  reality,  they  are  not  necessary;  for,  if  the  suf- 
ferer will  only,  by  the  light  of  his  common-sense,  revise 
his  mode  of  life,  removing  therefrom  what  by  common 
experience  of  mankind  is  noxious,  diligently  pursuing  that 
which  is  health-promoting,  he  will  rarely  fail  to  expel  the 
cause  of  every  functional  derangement,  whether  of  the 
heart  or  of  any  other  organ. 

A  few  words,  ere  we  leave  this  subject,  on  the  diagnosis 
of  heart  disease. 

Though  to  the  physician,  possessed  of  a  quick  ear,  the 
differentiation  between  organic  and  functional  disease, 
and  between  the  various  grades  of  each,  is  usually  a  mat- 
ter of  great  ease  and  simplicity,  yet  the  amateur  physician 
can  never  be  recommended  to  handle  the  stethoscope  wdth 
a  view  to  the  makino^  of  a  diao-nosis. 

Even  the  professional  man  may,  for  the  following  rea- 
sons, be  himself  at  fault. 

A  heart  may  be  healthy,  adequate  to  all  the  needs  of  a 
long  life  in  its  possessor,  and  yet  may  not  conform  to  the 
ordinary  standard  of  regularity  or  rhythm,  recognized  as 
characteristic  of  a  healthy  organ.  Even  the  position  of 
the  heart  may  be  abnormal,  and  yet  the  malplacement  be 
productive  of  no  ill  results. 

Again,  consistently  with  perfect  structure,  loud  "mur- 
murs," similar  to  those  produced  by  valvular  disease,  may, 
in  bodily  states  marked  by  a  deficiency  of  red-blood  cor- 
puscles (Chlorosis),  or  by  such  deficiency,  plus  a  lack  in 
the  other  blood  constituents  (AnaBmia),  be  heard.  Usually 
in  these  cases  the  differential  diagnosis  may  be  made  by  a 
study  of  the  area  within  which  the  murmurs  are  most  dis- 
tinctly heard ;  but  in  others,  the  poor  condition  of  the 
blood,  and  the  absence  in  the  medical  history  of  any  ill- 
ness that  can  produce  actual  disease,  must  be  relied  on. 


332       DISORDERS    OF    THE    HEART    AND    BLOOD-VESSELS. 

These  "  functional  murmurs,"  as  they  are  called,  disap- 
pear as  soon  as  the  condition  of  the  blood  is,  by  means  of 
pure  air,  rest,  and  well-selected  food,  restored  to  the  nat- 
ural state.  A  visit  to  a  ferruginous  spring  is,  in  some  ob- 
stinate cases  of  anfemia,  commendable. 

Diseases  of  the  Arteries,  Capillaries,  and  Veins. 

Inflammation  of  the  arteries,  thou G^h  it  does  actually  oc- 
cur,  is  so  exceedingly  uncommon  as  to  demand  no  notice 
at  our  hands.  As  with  the  heart,  so  with  these  vessels,  it 
is  the  lining  membrane  (the  endarterium)  wiiich  generally 
is  the  seat  of  inflammatory  mischief. 

Inflammation  of  the  capillaries  is  practically  unknown 
as  a  primary  disease. 

Inflammation  of  the  veins  (Phlebitis)  is  not  an  uncom- 
mon sequence  of  the  distension  and  bulging  of  these  chan- 
nels, characteristic  of  the  varicose  condition.  It  is  there- 
fore most  frequently  seen  in  the  lying-in  room,  within  the 
first  month  which  succeeds  parturition.  It  is  one  of  the 
great  causes  of  "  white  leg  "  or  "  milk  leg." 

The  first  consequences  of  inflammation  in  a  vein  are 
roughening  and  swelling  of  its  inner  surface,  which  speed- 
ily lead  to  coagulation  of  its  contained  blood.  The  co- 
aofulum  formed  is  called  a  "  Thrombus."  This  will  lead  to 
one  of  three  terminations  :  (1)  the  vein  and  clot  may 
gradually  shrivel  and  disappear;  (2)  the  clot  may  set  up 
irritation  and  lead  to  the  formation  of  a  curative  abscess; 
or  (3)  a  portion  of  the  clot  may  break  off  and  be  swept 
on,  perhaps  in  a  semi-decomposing  condition,  to  a  distant 
blood-vessel,  which  it  may  occlude,  or  wherein  it  may  devel- 
op an  abscess,  leading  in  its  turn  to  other  abscesses.  Such 
r.  travelled  thrombus  is  called  an  emholus^  and  the  sufferers 
from  either  are  said  to  be  suffering  respectively  from 
thrombosis  or  embolism.     Tlirombi  may  form  on  any  ir- 


ARTERIAL    DISEASES.  333 

regular  surface,  sucli  as  a  heart  valve  roughened  by  in- 
flammation of  its  lining,  and  are  then  apt  to  be  swept 
away,  to  lodge  not  infrequently  in  the  brain,  producing 
sudden  and  grave  mischief. 

The  line  of  treatment  in  thrombosis  is  evident,  for,  since 
in  the  breaking  up  of  the  clot  and  the  migration  of  its 
particles  lies  the  greatest  risk,  absolute  rest  is  a  first  essen- 
tial. Pain  may  be  relieved  by  the  application  of  heat  in 
the  form  of  poultices  or  hot  fomentations.  Friction  over 
the  seat  of  the  thrombus  is,  of  course,  to  be  rigidly  avoided. 

By  far  the  most  frequent  seat  of  thrombus  is,  as  I  have 
said,  the  leg,  and  the  above  treatment  is  suitable  to  this 
disorder  when  occurring  in  that  locality.  When  thrombi 
form  in  the  heart  there  is  usually  no  warning  of  the  dan- 
ger, and  therefore  no  time  for  treatment.  , 

Atony,  or  lack  of  tone,  in  the  arteries  and  veins,  or  rather 
in  their  muscular  coats,  is  an  accompaniment  of  general 
muscular  debility.  The  extent  of  its  presence  may  be 
roughly  gauged  by  the  amount  of  vertigo  or  faintness 
which  follows  when  the  head,  after  being  bent  to  a  lower 
level  than  the  trunk,  is  suddenly  raised.  The  treatment 
consists  in  improvement  of  the  general  muscular  tone  of 
the  whole  body. 

Degeneration  of  the  blood-vessels  of  the  body  is  common, 
and  is  one  of  the  most  frequent  causes  of  premature  and 
even  sudden  death. 

Disease  of  this  nature  comes  on  first  in  the  arteries, 
where  its  consequences  are  grave;  only  quite  in  the  later 
stages  do  the  veins  become  affected,  the  disorder  usually 
proving  fatal  ere  the  latter  are  noticeably  impaired. 

Two  great  causes  lead  to  degeneration  of  the  arteries: 
their  systematic  overwork  and  chronic  inflammation  of 
their  lining  membrane. 

Only  in  professional  athletes,  and  under   quite  excep- 


334       DISORDERS    OF    THE    HEART    AND    BLOOD-VESSELS. 

tionally  severe  and  prolonged  manual  labor  on  an  insuffi- 
cient dietary,  can  early  degeneration  of  the  arteries  be  the 
result  of  simple  overwork,  and  even  in  these  eases  it  may 
be  said  that  the  disease  is  a  normal  phenomenon  of  a  pre- 
mature old  age,  and  no  more  entitled  to  be  ranked  as  a 
disease  than  the  perfectly  natural  degenerations  of  the 
blood-vessels  and  of  the  body  at  large  which  are  the  nec- 
essary sequences  of  all  old  age.  The  athlete,  in  short, 
deliberately  "forces  the  pace"  of  the  circulatory  appa- 
ratus, and  brings  about  a  premature  breakdown  thereof, 
this  end  being,  however,  only  reached  when  the  apparatus 
has  done,  so  to  speak,  a  full  and  fair,  if  a  condensed,  life- 
work. 

Chronic  inflammation  of  the  lining  of  the  arteries,  the 
second  great  cause,  thus  works  its  ends:  in  the  first  place 
there  is,  as  the  result  of  a  disease  affecting  mainly  the 
lymphatic  system,  and  hence  the  internal  lining  of  the 
arteries,  which,  like  that  of  the  heart,  is  a  lymphatic  struct- 
ure— and  such  diseases  are  syphilis,  rheumatism,  and  gout 
— chronic  inflammation  of  the  inner  coat  of  the  artery, 
which  results  first  in  a  thickening  and  hardening  of  it,  and 
then  in  its  fatty  degeneration^  or  in  the  deposit  of  salts 
of  lime  in  the  middle  coat  of  the  artery,  which  latter  is 
styled  calcareous  degeneration. 

The  existence  of  this  degeneration  in  any  of  its  stages 
is  usually  recognizable  by  the  thickening  and  tortuosity 
produced  in  the  arteries,  which,  in  the  arteries  to  the  tem- 
yjles,  and  sometimes  even  in  those  of  the  pulse,  are  plainly 
visible. 

The  dangers  are  :  (1)  the  formation  of  blood-clots 
(thrombi)  on  the  thickened  and  roughened  inner  lining  of 
the  arteries;  (2)  the  partial  giving  way  of  an  artery  and 
the  consequent  formation  on  one  of  them — often  the  great 
main  channel,  the  aorta,  which  has  to  bear  most  strain — 


TREATMENT    OF    ARTERIAL    DISEASES.  335 

of  a  small  blood  sac,  which  grows  by  the  constant  force 
of  the  blood-stream,  till  it  either  causes  death  by  burst- 
ing, or  by  eroding  in  its  growth  some  vital  organ;  such  a 
blood-filled  sac  is  called  an  Aneurism.  (3)  In  place  of 
this  partial  and  gradual  rupture,  sudden  fracture  of  a 
blood-vessel,  usually  in  a  portion  of  the  body  where  the 
blood-vessel  receives  least  collateral  support,  such  as  the 
brain,  may  occur.  If,  as  generally  happens,  the  brain  is 
the  seat  of  the  consequent  blood  effusion,  the  disease 
called  Apoplexy,  so  common  a  sequence  of  the  arterial  de- 
generation natural  to  old  age,  occurs. 

The  resulting  pressure  on  the  brain  generally  leads  to 
unilateral  paralysis,  but  may  sometimes  cause  sudden 
death. 

Treatment. — The  first  object  in  treatment  is  to  modify 
the  influence  of,  or,  if  possible,  to  remove,  the  cause  at 
work  in  the  production  of  arterial  degenerations.  This 
will  check  at  least  the  rapid  advance  of  the  malady.  The 
mischief  actually  done  is,  of  course,  irremediable,  and  our 
attention  must  therefore  be  confined  to  the  careful  avoid- 
ance of  the  secondary  consequences  attendant  on  degener- 
ation, such  as  rupture,  partial  or  complete,  of  the  weak- 
ened blood-vessels.  This  end  is  only  to  be  obtained  by 
rest  and  quiet,  especially  by  the  avoidance  of  sudden  and 
violent  effort.  The  treatment  of  a  formed  aneurism  re- 
solves itself,  according  to  the  site  and  size  of  the  blood 
sac,  either  into  the  adoption  of  surgical  means  of  cure  or 
of  palliative  measures,  of  which  rest,  I  need  hardly  say, 
is  the  chief. 


CHAPTER  XII. 

DISEASES  DUE  TO   DEFECTS   IN  THE   ORGANS   OF 
THE   FOOD   SYSTEM. 

Disorders  of  the  Blood  and  Blood-making  Glands. — Structure  and 
Functions  of  the  Blood. 

THE  DISEASES  OP  THE  BLOOD. 

I.  Bue  to  non-living  poisons  in  the  Blood — e.  g.,  Lead,  Arsenic,  Mer- 

cury, etc. 

II.  Due  to  living  poisons  {Bacteria)  in  the  Blood,  producing  the 

Fevers  : 

(a)  Bacteria  that  enter  by  the  stomach  or  lungs  cause  the 

following  diseases:  Simple  Continued  Fever,  Mumps, 
Influenza,  Measles,  Epidemic  Roseola,  Scarlet  Fever, 
Typhoid  Fever,  Typhus  Fever,  Famine  Fever,  Yellow 
Fever,  Dengue,  Small -pox.  Chicken-pox,  Remittent 
Fever,  Intermittent  Fever  (Ague),  Epidemic  Cerehro- 
spinlil  Meningitis,  Cholera,  Diphtheria  and  Diptheritic 
Croup,  Whooping-cough. 

(b)  Bacteria  that  enter  only  by  a  wound  cause  the  following: 

Syphilis,  Tuberculosis,  Erysipelas,  Pyaemia,  Tetanus, 
Hydrophobia. 

III.  Due  to  unJcnoicn  changes  in  the  Blood. — Purpura,  Scurvy. 

THE   DISEASES  OF   THE   BLOOD-MAKING   GLANDS. 

LeucocythaBmia,  Adenia,  Addison's  Disease,  Progressive  Pernicious 
Anaemia,  Simple  Anaemia,  Chlorosis,  Exophthalmic  Goitre. 
15 


ZhC    ^OOb    B^BtCm—{co7itim(ed). 


CHAPTER  XII. 

DISEASES  DUE  TO  DEFECTS  IN  THE  ORGANS  OF  THE 

FOOD  SYSTEM. 

II.  AND  m. — DISORDERS  OF   THE  BLOOD   A^^D    OF   THE   BLOOD- 
FORMESfG  GLANDS. 

A  woED  first  as  to  the  composition  and  the  functions  of 
the  blood  in  health. 

Its  CompositiO}i. — Human  blood  consists  of  a  liquid  and 
a  solid  portion. 

T/ie  liquid  part,  the  plasma,  is,  as  I  have  more  than 
once  stated,  the  final  representative  in  the  body  of  the 
foods  consumed.  It  will  therefore  not  surprise  us  to 
know  that  it  contains,  on  an  average,  of  soluble  albumen,  8 
to  9  per  cent.;  of  grape-sugar,  of  fat,  and  of  various  min- 
eral salts,  of  each,  from  1  to  2  per  cent.;  and  of  water 
nearly  90  per  cent.  In  addition,  it  holds  in  solution  the 
debris  of  cells,  represented  by  urea,  and  minute  traces  of 
extractives  of  different  kinds. 

The  solid  portion  is  made  up  of  two  varieties  of  minute 
bodies,  the  so-called  corpuscles,  the  one  kind  plentiful, 
round,  and  colored — red  when  stored  with  oxygen  in  the 
arteries,  purple  when  laden  with  carbonic  acid  in  the 
veins ;  the  other  variety  scanty,  of  varying  shape,  and 
nearly  colorless. 


340  DISOKDEES    OF    THE   BLOOD. 

The  colored  corpuscles  (the  so-called  red-blood  corpus- 
cles) are  mere  mechanical  carriers  of  oxygen  to,  and  of 
carbonic  acid  from,  the  tissues  ;  the  colorless  ones  (the  so- 
called  white-blood  corpuscles)  are  living  amoeboid  cells, 
and  have  the  power  of  leaving  the  fine-walled  capillaries 
of  the  body  and  of  wandering  among  the  fixed  body  cells. 

The  white-blood  corpuscles  are,  there  is  strong  reason 
to  believe,  manufactured  in  the  s^^leen  and  the  lymphatic 
glands,  j^ossibly  also  in  the  thymus,  thyroid,  and  other 
small  and  unimportant  organs.  As  to  the  origin  of  the 
red-blood  corpuscles  there  is  still  much  diversity  of  opin- 
ion, some  physiologists  maintaining,  with  Kolliker,  that 
they  are  only  altered  white  corpuscles  ;  others,  with  Neu- 
mann and  Bizzozero,  that  they  are  developed  indepen- 
dently of  them  in  the  red  marrow  of  bones. 

The  Functions  of  the  Blood. — The  plasma  nourishes  the 
tissues,  including  the  white  and  red  blood  corpuscles.  The 
red-blood  corpuscles  convey  oxygen  to,  and  carbonic  acid 
away  from,  the  cells  of  the  body,  while  the  exact  role  of 
the  white  corpuscles  in  the  bodily  economy  is  as  yet  a 
matter  of  speculation. 

11.  DISORDERS  OF  THE  BLOOD. 

We  have  already,  in  an  earlier  chapter,  dealt  wdth  the 
results  both  of  a  mere  poverty  and  of  an  over-richness  of 
the  blood  plasma  ;  we  now  come  to  the  actual  diseases  of 
the  blood,  due  to  the  presence  within  it  of  poisonous  sub- 
stances. Of  these  there  are  tw^o  great  varieties,  the  non- 
living and  the  living. 

Blood  Poisons  not  endowed  with  Life. — Minerals  foreign 
to  the  body  may,  when  taken  in  the  form  of  salts  soluble 
in  the  digestive  juices,  pass  through  the  liver  witli  the 
other  and  necessary  salts  contained  in  water  and  food,  and 
thus  enter  the  blood-stream. 


VARIOUS    MINERAL    BLOOD    POISONS.  341 

It  is  therefore  in  the  liver  that  traces  of  poison,  when 
death  by  poisoning  is  suspected,  are  primarily  to  be  looked 
for.  But  poisons  do  not  pass  that  great  janitor  at  the 
entrance  of  the  circulation,  the  liver,  unchallenged  or  un- 
opposed. Not  that  this  organ  is  endowed  with  a  sense  of 
right  or  wrong,  but  that,  simply  as  a  result  of  its  develop- 
ment, it  is  adapted  to  give  a  free  passage  only  to  certain 
accustomed  articles,  and  as  most  poisons  differ  in  their 
chemical  characters  widely  from  albumen,  grape-sugar,  or 
the  chlorides  of  sodium,  of  potassium,  etc.,  they  are  liable 
to  be  arrested  and  sent  to  the  right-about  with  other  ex- 
creta by  way  of  the  bile  ducts,  and  this  arrest  and  the 
disturbance  of  the  biliary  function  which  ensues  there- 
upon are  evidenced  by  a  severe  attack  of  a  form  of  bil- 
iousness, accompanied  by  headache  and  sickness,  the  first 
warning  the  body  often  receives  of  the  presence  within  it 
of  any  form  of  poison,  from  a  mineral  such  as  arsenic  to 
the  living  bacillus  of  yellow  fever. 

The  early  fathers  of  medicine  were  not  slow  to  read  the 
meaning  and  uses  of  such  phenomena,  and  everywhere  in 
their  works  we  find  that  the  recommendations  for  the  early 
treatment  of  fever  included,  as  an  agent  of  first  impor- 
tance, an  emetic,  modern  science  confirming  in  this,  as  in 
many  other  of  their  supposed  mistakes,  the  perspicuity  of 
their  observations  and  the  correctness  of  their  deductions. 

Among  mineral  poisons,  lead,  arsenic,  and  mercury  hdiYe 
become  more  or  less  familiar  to  the  public,  at  least  in  the 
pages  of  the  press,  if  never  in  the  experiences  of  actual 
life.  When  a  single  large  dose  of  any  of  these,  or  of  kin- 
dred mineral  poisons,  has  been  swallowed,  the  symjDtoms 
that  arise  are  so  urgent,  so  alarming,  and  so  characteristic, 
that  they  can  barely  escape  the  recognition  of  any  intelli- 
gent man.  It  is  therefore  only  in  small  and  oft-repeated 
doses  that  lead  and  arsenic  become  formidable  through 


342  DISORDERS    OF    THE    BLOOD. 

the  slow  and  insidious  saj^ping  of  the  general  health  re- 
sulting from  their  consumption. 

Leaving  aside  those  who  have  the  handling  of  the  poi- 
sonous lead  salts — i.  e.,  plumbers,  painters,  and  oilmen, 
and  who  well  understand  the  risks  they  run  in  the  pursuit 
of  their  respective  businesses — the  only  source  of  danger 
to  a  member  of  the  general  public  from  lead  poisoning 
lies  in  the  water  he  consumes.  Soft  water  and  distilled 
water,  if  in  contact  with  metallic  lead,  become  rapidly 
contaminated — as,  by  the  way,  do  also  cider,  perry,  and 
acid  wines.  Some  of  the  hard  waters  may  even  be  dan- 
gerous if  conveyed  in  lead  pipes  or  stored  in  cisterns  of 
that  metal,  and  therefore  in  the  country  it  is  well  either 
to  avoid  such  conveyance  and  storage,  or  to  have  the  wa- 
ter carefully  analyzed.  In  towns  this  matter  receives 
careful  supervision  at  the  hands  of  eminent  scientists. 

Arsenical  poisoning  usually  takes  its  rise  in  the  employ- 
ment of  arsenical  dyes  for  articles  of  clothing  or  for  wall- 
paper. 

Material  of  vegetable  origin,  such  as  opium,  morpldna, 
strychnina,  jjriissic  acid,  belladonna,  etc.,  may  become  a 
source  of  danger,  and  here,  as  in  the  case  of  mineral  and 
fever  poisons,  if  the  dose  consumed  is  great,  the  conse- 
quent derangements  act  at  once  as  a  warning  and  a  cure — 
at  least  of  a  partial  nature — sometimes  the  stomach  and 
bowel,  and  sometimes  the  liver,  playing  the  part  of  the 
policeman,  and  seeking  to  eject  the  intruder.  Indeed,  it 
is  to  the  action  of  those  organs  that  we  are  indebted  for 
the  sometimes  very  useful  purgation  or  emesis  set  up  by 
medicaments.  The  results  of  ipecacuanha  on  the  stomach, 
of  aloes  on  the  intestine,  and  of  podophyllin  on  the  liver, 
are  merely  due  to  the  repellent  effects  of  each  of  those  or- 
gans on  the  drug.  If,  moreover,  we  continue  to  swallow 
these  drugs  in  the  same  quantities  we  shall  find  that  the 


ACTION    OF    POISONS.  343 

characteristic  pheuomena  produced  by  each  become  less 
and  less  marked,  and  finally  cease.  Then  we  say  that  tol- 
erance  of  the  drug  has  become  established;  each  organ 
has,  in  short,  become  educated,  as  it  were,  to  deal  with 
each  of  those  vegetable  extracts,  to  accept  them  as  one  of 
the  ordinary  conditions  of  life,  and  a  discontinuance  of 
them  will  then,  for  a  time  at  any  rate,  cause  a  derange- 
ment of  the  bodily  health. 

These  remarks  are  true  of  all  jDoisons,  though  of  some, 
probably  of  those  which  have  most  chemical  affinity  to 
bodily  factors,  more  so  than  of  others.  Thus  arsenic, 
which  has  in  many  ways  a  resemblance  to  iron,  a  normal 
ingredient  in  red-blood  corpuscles,  can,  if  the  dosage  is 
carefully  graduated,  be  eventually  consumed  by  man  in 
large  quantities  without  apparent  gross  derangement  of 
health;  the  same  may  be  said  of  opium,  the  consumption 
of  large  quantities  of  which  is  not  incompatible  with  a 
long  life.  Even  a  tolerance  of  the  most  deadly  fever  poi- 
sons may,  as  we  know,  after  an  education  of  the  bodily 
tissues,  which,  however,  must,  as  a  rule,  extend  over  gen- 
erations, be  established  —  the  negro  races  who  brought 
yellow  fever  to  America  enjoying  now  almost  complete 
immunity  from  the  scourge  ;  the  same  being  true  of  the 
European  races  as  regards  measles,  and  to  a  large  extent 
as  regards  small-pox,  the  former  of  which  acts  as  a  malig- 
nant enemy  to  many  black  races,  while  the  latter  scarcely 
grants  them  any  chance  of  escape. 

It  is  obviously  impossible,  even  were  it  judicious  to  make 
the  attempt,  to  deal  in  the  limit  of  these  pages  with  the 
symptoms  and  the  treatment  of  cases  of  rapid  or  of  slow 
poisoning.  I  need  only  say  that  if  any  portion  of  the  poi- 
son consumed  yet  remains  in  the  alimentary  canal  it  must, 
first  of  all,  and  as  far  as  possible,  be  ejected  therefrom  by 
means  of  artificially  induced  vomiting  or  purgation,  while 


344  DISORDERS    OF    THE    BLOOD. 

the  small  balance  which  may  be  assumed  to  have  escaped 
expulsion  by  those  means  should  be  rendered  harmless  by 
the  administration  of  antidotes  —  that  is,  of  substances 
which  can  so  act  on  it  as  to  render  it  insoluble  in  the  di- 
gestive juices  and  therefore  incapable  of  absorption  into 
the  blood;  while,  finally,  the  emission  of  that  part  that 
may  have  already  entered  the  blood-stream  must  be  un- 
dertaken by  the  skin  and  kidneys,  whose  full  action  should 
be  encouraged.  Such,  in  tlie  vast  majority  of  cases,  is  the 
rational  line  of  treatment. 

Living  Blood  Poisons. 

Under  certain  conditions,  living  micro-organisms  of  an 
unusual  kind  enter  the  blood-stream,  multiply — and  in  so 
doing  raise  a  fermentative  series  of  changes — therein,  and 
produce  certain  well-known  varieties  of  disease,  among 
which  the  most  numerous  and  the  best  known  are  the 
fevers. 

Twenty  years  ago  the  above  proposition  would  have 
been  ridiculed  ;  to-day  it  receives  the  almost  unanimous 
consent  of  the  medical  world.  Unlike  most  medical  theo- 
ries, which  have  been  developed  in  the  fertile  brain  of  some 
chamber  medical  philosopher  and  have  naught  but  a  subtle 
metaphysical  basis  to  recommend  them,  the  doctrine  of  the 
bacterial  origin  of  fevers  rests  chiefly  on  ocular  proofs, 
requires  no  special  medical  training  for  its  fullest  compre- 
hension, and  can  with  confidence  appeal  to  the  whole  scien- 
tific world,  professional  and  lay,  for  a  verdict. 

Medical  pathology,  while  busy  in  sketching  and  tabu- 
lating the  many  phases  of  human  shipwreck,  and  in  that 
capacity  long  of  little  practical  service  to  the  physician  in 
his  combat  witli  disease,  has  in  these  latter  days  discov- 
ered the  causa  caicsans  of  fever,  and  is  now  largely  em- 
ployed  in    carefully   compiling   a   series  of  observations 


FEVERS    DUE    TO    LIVIXG    BLOOD    POISONS.  345 

which  bid  fair  to  assist  humanity  in  that  which  humanity 
has  alwaj^s  demanded  at  the  hands  of  medical  science,  the 
avoidance  of  shipwreck. 

In  the  form  of  separate  propositions  I  will  now  tabulate, 
firstly,  the  results  of  experiments  susceptible  of  accurate 
proof  ;  and,  secondly,  the  deductions  drawn  therefrom. 

It  has  been  proved  that — 

(a)  The  air,  not  only  that  we  breathe,  but  that  contained 
in  all  liquids  and  solids,  in  every  region  of  the  earth,  is 
laden  with  living  organisms  called,  by  reason  of  their  small- 
ness,  micro-organisms. 

(b)  That  these  micro-organisms  are  the  sole  causes  of 
that  fermentative  change,  called  putrefaction,  which  com- 
mences when  the  vital  power  of  living  organisms  fails,  and 
which,  when  vitality  is  extinguished,  restores  organic  mat- 
ter to  the  inorganic  form. 

(c)  That  the  form  and  consequently  the  powers  of  micro- 
organisms are,  like  those  of  all  living  creatures,  modified 
or  destroyed  by  changes  in  their  environment. 

(d)  That  the  following  conditions  aifect  them  greatly  : 

(1)  Temperature. 

(2)  Moisture. 

(3)  Amount  of  oxygen  present. 

(4)  Amount  and  variety  of  their  pabulum  present. 

(e)  That,  according  to  the  combination  of  circumstances 
arranged,  special  micro-organisms  may  be  cultivated.  A 
high  temperature  (80°  F.  to  180°  F.),  moisture,  comparative 
absence  of  oxygen,  and  the  presence  of  a  large  amount  of 
dead  organic  matter  being  generally  most  favorable,  and 
the  opposite  conditions  those  least  favorable,  to  the  rapid 
evolution  and  development  of  these  micro-organisms.  In 
fact,  conditions  unusual  in  Nature  result  in  an  equally 
unusual  micro-organism,  while  the  ordinary  conditions  on 
this  earth  tend  but  to  keep  alive  the  common  varieties. 

15* 


346  DISORDERS    OF    THE    BLOOD. 

The  more  unusual  the  conditions,  the  more  unusual,  as  a 
rule,  the  resulting  micro-organism. 

(/)  That  a  new  variety  once  developed  may  be  per- 
petuated indefinitely  under  favorable  conditions.* 

So  far  the  laboratory  experiments  carry  us ;  now  for 
fair  deductions  : 

(a)  The  body  of  man  has  become  habituated  to  the  in- 
breathing and  consumption  of  the  ordinary  varieties  of 
micro-organisms,  and  these  are  not  only  therefore  innocu- 
ous, but  probably  even  useful,  to  his  economy. 

(b)  The  new  forms  of  bacteria  developed  under  unusual 
conditions  act  on  man  as  do  those  minerals  and  vegetable 
extracts  to  which  his  body  is  unaccustomed,  as  antagonistic 
forces,  or  what  are  called  poisons. 

(c)  Bacteria  being  living  ferments,  like  the  yeast  plant, 
and  the  blood,  the  fluid  in  which  they  act,  of  restricted 
amount,  for  it  can  undergo  scarce  any  replenishment  in 
fevers,  it  will  follow  that  the  fevers  will  all  end  in  sponta- 
neous cure,  the  bacteria  dying,  either  because  their  normal 
life-term  is  reached,  or,  much  more  probably,  because  the 
accumulation  of  the  chemical  products  of  their  fermenta- 
tion destroy  them,  just  as  the  yeast  plant  is  killed  by  the 
alcohol  it  itself  has  produced  when  that  alcohol  exceeds  20 
per  cent,  of  the  total  fluid. 

Thus  the  question  stands  at  the  present  day. 

The  diseases  which  result  from  the  entrance  of  micro- 
organisms, of  living  ferments,  into  the  blood  are  known 
as  the  idio2mthic  fevers,  and  are  to  be  distinguished  from 
fever  the  result  of  a  local  inflammation. 

The  following  is  but  an  imperfect  list  of  the  idiopathic 

*  Tlie  spores  are  surrounded  by  a  thicker  and  stronger  cell-wall 
than  are  the  bacteria  from  which  they  develop.  They  are  conse- 
quently hardier  products  than  the  original  bacteria.  {Brit.  Med. 
Journal,  Dec.  8, 1888,  Address  by  Professor  Chartcris.) 


A    LIST    OF    THE    IDIOPATHIC    FEVERS. 


347 


fevers.  In  some  of  tbem  there  is  direct  proof  that  a 
micro-organism  is  concerned  in  their  production  ;  in  others 
the  evidence  is  not  so  complete,  but  is  still  strong.  Others 
of  really  doubtful  origin,  such  as  pneumonia,  I  have  omit- 
ted from  the  list  and  reluctantly  ranged  under  the  old 
classification : 


Simple  continued  fever. 

Mumps. 

Influenza. 

Measles. 

Epidemic  roseola  (German 

measles). 
Scarlet  fever. 
Typhoid  " 
Typhus    " 
Famine     " 
Yellow     " 
Dengue 
Small-j^ox. 
Chicken-pox. 
Remittent  fever. 


Intermittent  fever  (ague 
or  malarial  fever). 

Epidemic  cerebro- spinal 
menino-itis. 

Cholera. 

Diphtheritic  croup. 

Whooping-cough. 

Syphilis. 

Tuberculosis. 

Erysipelas. 

Pyaemia  (including  puer- 
peral fever). 

Tetanus  (lock-jaw). 

Hydrophobia. 


The  last  six  of  this  list  we  shall  consider  by  themselves, 
as  they  are  separated  by  certain  characters  from  the  other 
fevers. 

Characters  common  to  all  Severs. 

In  all  fevers  there  are  observable  distinct  stages.  These 
are  named  those  of  Inciibati07i,  of  Invasion,  of  Advance, 
and  of  JResolution. 

The  stage  of  Incubation  is  that  period,  varying  from  a 
few  hours  in  diphtheria  to  a  few  weeks  in  hydrophobia, 
which  elapses  between  the  time  when  the  germ  enters  the 
body  and  the  first  commencement  of  urgent  symptoms,  the 
first  appearance  of  the  distinctive  characters  of  fever.     It 


348  DISORDERS    OF    THE    BLOOD. 

is  not  by  any  means  easy  to  account  in  a  satisfactory  man- 
ner for  the  existence  of  this  stage  and  its  varying  length, 
not  only  in  different  fevers,  but  sometimes  in  different 
specimens  of  the  same  fever.  It  is  possible,  moreover, 
that  the  same  explanation  might  not  cover  all  instances  of 
fever.  It  is  probable  that  only  the  spores  of  fever  germs 
are  generally  consumed  by  the  person  who  catches  fever, 
and  in  such  a  case  some  little  time  must  be  allowed  for 
their  development  in  the  body  of  the  new  host ;  or  again 
it  may  be  that  fever  symptoms  are  the  result  of  the  chemi- 
cal products  of  fermentation,  rather  than  of  the  presence 
of  the  ferments  themselves,  and  some  period  will  then 
elapse  ere  such  accumulate  in  sufficient  quantity  to  vio- 
lently derange  the  health.  We  know,  for  a  certainty,  that 
in  some  diseases  (e.  ^.,  in  gout),  as  sharp  and  acute  in  their 
onset  as  fevers,  the  special  blood  poison  productive  of  the 
symptoms  may  accumulate  for  weeks,  months,  or  even 
years  in  the  blood  ere  it  develops  the  acute  attack.  Dur- 
ing the  stage  of  incubation  there  is,  as  a  rule,  only  vague 
general  malaise. 

The  stage  of  Invasion  commences  with  the  more  urgent 
symptoms.  Of  such,  the  commonest,  given  in  their  usual 
order,  are  rigors  (shivering  fits,  felt  mostl}^  down  the 
spino),  headache,  nausea  or  vomiting,  a  rapid  pulse,  a  hot, 
dry,  burning  skin,  loss  of  appetite,  thirst,  etc. — in  one  word, 
fever. 

The  stage  of  Advance  can  scarcely  be  viewed  as  anything 
but  the  direct  continuation  of  the  invasion  stage.  Symp- 
toms continue,  and  fresh  ones,  among  which  often  are  skin 
eruptions,  appear. 

The  stage  of  Resolution  is  usually  held  to  date  from  the 
first  commencement  of  imj^rovement  to  the  advent  of  con- 
valescence, the  cessation  of  the  fever.  In  some  fevers  this 
stage  occupies  but  a  few  hours.     In  typlius,  for  instance, 


SIMPLE    CONTINUED    FEVER.  349 

a  fever  patient  will  not  unfrequently  pass,  in  the  course  of 
three  or  four  hours,  from  a  very  high  state  of  fever  to  a 
condition  in  which  all  fever  and  symptoms  of  fever  have 
passed  away.  This  is  called  a  Crisis.  In  most  cases  of 
fever,  however,  the  improvement  which  marks  the  stage 
of  resolution  is  slow  and  extends  over  several  days.  This 
latter  termination  of  fever  is  said  to  be  by  Lysis. 

The  symptoms  of  fever  are  the  results  of  the  efforts 
made  by  the  body  to  establish,  in  the  presence  of  a  novel 
force  (the  bacterium)  or  of  a  series  of  novel  forces  (the 
products  of  bacterial  fermentation)  a  condition  of  equilib- 
rium, a  modus  vivendi. 

The  treatment  of  fever  consists — in  the  absence  of  any 
antidote  to  the  fever  poison — in  judicious  assistance  ren- 
dered to  the  body  in  those  efforts. 

We  will  now  briefly  touch  on  the  ordinary  and  more 
salient  features  of  each  of  these  disorders. 

Simple  Continued  Fever. 
Caused  hy  a  micro-organism,  but  favored  by  exjDosure, 
over-fatigue,  and  damp. 
Characterized  hy : 

(1)  ^  stage  of  incuhatioii  of  varying  duration  and 
marked  by  only  trifling  general  malaise. 

(2)  A  stage  of  invasion,  marked  by  shivering  and  some 
nausea. 

(3.)  A  stage  of  advance,  lasting  from  a  few  hours  to 
some  days  or  even  weeks,  marked  by  the  ordinary  signs 
of  fever,  but  unaccompanied  by  any  eruption. 

Hesulting  in  recovery  in  nearly  every  instance. 

It  is  neither  contagious  nor  infectious. 

Remarks. — The  "fever  and  ague"  of  the  tropics  and 
"jungle  fever"  are  often  quoted  as  examples  of  this  va- 
riety of  fever.     Each  of  them  is,  however,  probably  a 


350  DISORDERS    OF    THE    BLOOD, 

special  and  separate  fever  of  malarial  type.  Manj^  authori- 
ties ignore  the  existence  of  simple  continued  fever,  assert- 
ino-,  and  I  think  with  very  strong  reason,  that  the  so-called 
examples  of  this  fever  met  with  are  really  masked  attacks 
of  some  one  or  other  of  the  real  fevers,  or  are  mere  gen- 
eral disturbances  due  to  some  internal,  and  not  easily  dis- 
coverable, inflammatory  derangement,  often  of  the  nature 
of  gastric  catarrh. 

Mumps. 

Caused  by  a  micro-organism. 

Characterized  by  fever,  with  j^ain  and  sicelling  of  the 
parotid  or  other  salivary  (/lands. 

Resulting  generally  in  recovery  after  a  few  days. 

Remarks. — Mumps  is  propagated  by  contagion.  Metas- 
tasis, or  sudden  change  in  the  locality  of  the  swelHng,  is 
sometimes  seen  in  mumps  :  thus  the  enlargement  in  the 
neck  may  rapidly  subside,  while  the  testicles  or  breasts 
may  as  suddenly  commence  to  swell.  I  have  seen  death 
result  in  the  course  of  a  few  hours  from  a  sudden  change 
of  venue  from  the  neck  to  the  membranes  of  the  brain. 

Influenza. 

Caused  by  a  micro-organism,  developed  during  peculiar 
conditions  of  the  atmosphere. 

Characterized  by  sudden  chills,  gve^ii prostration,  frontal 
headache,  aching  of  the  limbs,  sneezing,  and  the  general 
signs  of  a  catarrh  of  the  respiratory  passages. 

Resulting  nearly  always  in  recovery,  whicli  often  is 
ushered  in  by  an  attack  of  diarrlioea. 

Remarks. — The  term  influenza  is  often  misapplied  to  an 
ordinary  attack  of  catarrh.  There  is  a  wnde  difference  be- 
tween the  two  disorders.  The  early  symptoms  of  influenza 
are  those  of  a  fever,  and  are  always  sudden  and  often  alarm- 
ing.    It  is  wswdiWy  epidemic,  2iw(\  affects,  almost  simultane- 


MEASLES.  351 

oiisly,  vast  numbers  of  persons.  Its  course  is  short,  rarely 
extending  beyond  a  week.  Its  cessation  is  often  sudden 
and  marked  by  diarrhoea  ov profuse  siceati7ig.  It  contrasts 
therefore  strongly  with  simple  catarrh. 

Measles. 
Caused  by  a  micro-organism. 
Characterized  by : 

(1)  A  stage  of  incubation  of  from  ten  to  fourteen  days, 
in  which  only  slight  malaise  is  felt.  Old-fashioned  nurses 
often  aver  in  this  period  that  the  child  is  "sickening"  for 
something. 

(2)  A  stage  of  invasion,  marked  by  nausea,  running  at 
the  nose  and  eyes,  intolerance  of  light,  and  general  discom- 
fort, and  lasting  three  or  four  days. 

(3)  A  stage  of  advance,  marked  by  the  appearance  first 
on  the  inside  of  the  throat,  and  then  on  the  face,  and  lastly 
on  the  trunk  and  extremities,  of  a  raised  eruptw?i,  at  first 
faintly  purple  or  pinkish,  but  gradually  deepening  in  hue, 
accompanied,  as  the  skin  eruption  becomes  darker  and 
more  copious,  by  cough  and  vc(7'ioiis  chest  symptoms,\3Lrge- 
ly  due  to  the  simultaneous  jDresence  within  the  bronchial 
tubes  of  an  identical  eruption. 

After  the  first  four  daj^s  of  this  stage,  the  eruption,  both 
internal  and  external,  commences  to  subside,  and,  unless 
some  grave  complication  bas  occurred,  steady  improvement 
commences. 

Hesidting  in  the  vast  majority  of  cases  in  prompt  re- 
covery, but  sometimes,  by  reason  of  such  not  infrequent 
complications  as  pneumonia,  bronchitis,  pleurisy,  whoop- 
ing-cough, or  diphtheria,  in  death  or  very  protracted  con- 
valescence. 

Memarks. — Measles  seem  to  be  most  contagious  during 
the  period  of  invasion.     "Peeling"  occurs  during  conva- 


352  DISORDERS    OF    THE    BLOOD. 

lescence,  the  skin  being  sbed  in  fine,  branny  scales.  This 
disease  has  a  strange  affinity  for  whooping-cough,  the  one 
disorder  not  infrequently  being  immediately  followed  by 
the  other.     Deafness  is  a  common  sequence  of  measles. 

Epidemic  Roseola  (German  Measles). 

Caused  by  a  micro-organism. 
Characterized  by : 

(1)  A  stage  of  incubation,  lasting  from  five  to  fourteen 
days,  marked  by  slight  malaise. 

(2)  A  stage  of  invasion,  lasting  from  a  few  hours  to 
four  days,  marked  by  nausea,  general  feverishness,  sore 
throat,  and  discomfort  i?i  the  respiratory  2^assages. 

(3)  A  stage  of  advance,  marked,  in  addition  to  the  last- 
mentioned  symptoms,  by  the  appearance,^/??'s^  on  the  breast 
and  arms,  of  an  elevated  rose-colored  rash,  which  often 
gradually  gives  place  to  a  general  confluent  redness  or  to 
large,  irregidar  red  patches.  This  stage  may  last  from 
four  to  sixteen  days. 

llesulting,  nearly  always,  in  recovery. 

Remarks.  — ■  Epidemic  rose-rash  differs  from  measles 
mainly  in  the  color  of  the  eruption  and  the  localities  in 
which  the  rash  first  appears,  while  it  contrasts  with  scar- 
let fever  by  the  discomfort  in  the  respiratory  passages 
rare  in  the  latter  fever,  by  the  absence  of  active  vomiting 
in  the  stage  of  invasion,  and  by  the  ultimate  course  pur- 
sued by  the  rash.  It  is  both  contagious  and  infectious, 
and  has  a  lower  mortality  than  either  measles  or  scarlet 
fever. 

Scarlet  Fever. 

Caused  by  a  micro-organism. 

Cliaracterized  by : 

(1)  A  stage  of  incubation,  lasting  from  one  to  ten  days, 


SCARLET   FEVER.  353 

and  marked  often  by  considerable  general  derangement  of 
health. 

(2)  A  stage  of  invasion,  lasting  from  twelve  to  twenty- 
four  hours,  and  marked  conspicuously  by  vomiting — ichicJi 
is  usually  severe  and  prolonged  according  as  the  attack  is 
had — sore  throat,  headache,  and  a  very  rapid  pulse. 

(3)  A  stage  of  advance,  marked  by  the  appearance,  ^^rs^ 
on  the  chest  and  neck,  and  then  on  the  trunk  and  extremi- 
ties, but  rarely  or  never  on  the  face,  of  a  red,  diffused  rash, 
apparently  made  up  of  an  wime?ise  number  of  minute  ele- 
vated points  (the  papillse  of  the  skin),  which  becomes  more 
general  and  takes  a  deeper  hue  daring  each  of  the  first 
three  days  of  its  continuance.  This  stage  is  further  char- 
acterized by  a  bright  red  tongue  (the  '■'■  strav:herry  tongue'''' 
of  scarlet  fever),  a  severely  inflamed  cond'ition  of  the  throat, 
Avhich  may  ulcerate  or  be  covered  with  diphtheritic  patches, 
a  rapid  pulse,  a  high  temperature,  and  general  nervous 
symptoms.  It  lasts  rarely  more  than  ten  or  twelve  days, 
by  the  end  of  which  time  the  rash  will  generally  have 
faded,  and  "  peeling "  of  the  skin,  which  usually  comes 
away  in  largish  flakes,  will  have  commenced. 

Hemarks. — The  following  facts  regarding  scarlet  fever 
must  be  borne  in  mind.  It  is  eminently  contagious  and 
infectious.  The  severity  of  the  attack,  which  may  gen- 
erally be  gauged  by  the  early  symptom  of  vomiting, 
varies  in  different  cases,  and  different  epidemics  differ 
widely  in  their  mortality.  Thus  scarlet  fever  may  either 
present  itself,  in  extreme  cases,  as  an  exceedingly  mild 
disorder,  and  as  such  may  even  be  unaccompanied  by  any 
rash,  or  as  a  highly  malignant  fever,  fatal  in  a  few  hours 
and  even  before  any  rash  has  had  time  to  appear.  All 
forms  of  it,  however,  the  mild  and  the  severe,  may  be  fol- 
lowed by  inflammation  of  the  kidneys,  which  may  j^ass 
into  a  form  of  chronic  JBrigMs  disease.     The  lymphatic 


354  DISORDERS    OF   THE    BLOOD. 

system  often  suffers  severely  during  the  continuance  of 
the  fever,  as  evidenced  by  inflammation  of  the  lymphatic 
glands,  and  of  the  great  lymphatic  spaces  that  encircle 
the  bowel,  the  lungs,  the  heart,  and  the  brain.  Peritoni- 
tis, pleurisy^  endocarditis,  pericarditis,  and  meningitis  are 
thus  not  unfrequent  complications.  Severe  rheumatism  is, 
as  we  should  naturally  expect  in  a  fever  which  attacks 
frequently  in  a  special  manner  the  lymphatic  system,  fre- 
quently observed,  while  disease  of  the  middle  and  internal 
ear,  ending  sometimes  in  permanent  deafness,  and  caused 
by  a  direct  extension  to  those  parts  of  the  inflammation 
which  commences  in  the  throat,  is  also  a  common  sequel 
of  the  disease. 

Scarlet  fever  is  especially  fatal  to  lying-in  women,  who 
are,  moreover,  remarkably  prone  to  contract  it.  In  the 
case  of  children,  the  scrofulous,  whose  lymphatic  system 
is  always  their  weak  point,  are  most  prone  to  succumb  to 
the  attack. 

Typhoid  Fever. 

Called  also  enteric  fever,  gastric  fever,  gastro-hilioits 
fever,  and  loio  fever. 

Caused  hy  a  micro-organism,  which  is  most  readily  de- 
veloped in  localities  such  as  cesspools,  and  badly  flushed 
or  defective  drains,  where  human  excreta  collect,  and 
where  the  temperature  rarely  falls  low,  and  to  which 
fresh  air  has  no  ready  access.  Once  developed,  the  bac- 
terium of  typhoid  travels  by  means  of  water,  milk,  or 
other  articles  of  food  contaminated,  but  probably  never 
by  the  air.  This  fever  germ  is  therefore  non-volatile,  and 
cannot  be  communicated  by  the  atmosphere  of  the  sick- 
room, and  probably  not  even  by  the  vapor-charged  breath 
of  the  sufferer. 

Clwracterized  usually  by  three  well-marked  stages,  but 


TYPHOID     FEVER.  355 

exhibiting  in  its  method  of  attack,  in  its  course  and  sever- 
ity, and  in  its  duration  very  wide  differences. 

(1)  A  variable  stage  of  i7icuhatio7i,  marked  usually  by  a 
peculiar  weakness  of  the  legs^  by  ^ova^  flatulence,  frontal 
headache,  and  general  malaise;  often  by  deafness. 

(2)  A  stage  of  invasion,  marked,  in  the  majority  of 
cases,  by  severe  frontal  headache,  nausea  and  vomiting, 
prostration  of  strength,  high  fever  {worse  at  night),  dis- 
tension of  and  gurgling  in  the  abdomen,  with  distinct  paiii 
on  pressure  in  the  lower  right-hand  corner  of  it  (the  right 
iliac  fossa),  and,  in  about  5  per  cent,  of  the  cases,  by  a 
brilliant  rose-colored  rash  lasting  for  one,  two,  or  three 
days. 

(3)  A  stage  of  advance,  marked  for  a  time  (one  to  two 
weeks)  by  the  occurrence,  in  90  per  cent,  of  the  cases,  of 
frequent  and  offensive  diarrhoea,  the  stools  being  very 
liquid  and  of  a  characteristic  mustard  hue;  by  the  ap- 
pearance of  a  faint  and  usually  very  scoMty  rose-colored 
rash,  best  seen  in  the  neighborhood  of  the  navel;  by  high 
nocturnal  fever,  with  generally  a  marked  amelioration  in 
the  early  part  of  the  day;  by  profuse  night-sweating;  by 
great  abdominal  distension,  and  often  by  extreme  loss  of 
power,  the  patient  lying  in  an  apathetic  state  on  his  back, 
the  lips  and  teeth  covered  with  dry  and  often  black  mu- 
cus, the  skin  exhaling  an  earthy  odor,  and  the  pupils  loide- 
ly  dilated. 

Towards  the  end  of  this  stage,  gradual  improvement  in 
all  the  symptoms  is  witnessed,  and  by  the  end  of  twenty- 
one  to  thirty  days  from  the  date  of  invasion  all  fever  has 
usually  subsided. 

The  stage  of  convalescence  is  a  long  one,  and  short  re- 
lapses, lasting  each  for  two  or  three  days,  are  very  com- 
mon. 

llemarks. — It  is  almost  impossible  to  do  justice,  in  a 


356  DISORDERS    OF    THE    BLOOD. 

very  limited  space,  to  a  subject  such  as  typhoid  fever,  for 
SO  diverse  are  often  the  earlier  symptoins  that  a  mal-diag- 
nosis  may  easily  be  made  by  the  most  experienced  men. 
The  sketch  I  have  given  is  that  of  a  typical  attack. 

The  characteristic  swelling  and  ulceration  of  some  of 
the  glands  in  the  intestine  (the  co-called  Peyerian  grouj^s 
and  the  solitary  glands)  introduces  an  element  of  danger 
from  perforation  of  the  bowel  and  peritonitis,  in  this 
fever,  absent  in  all  others.  Copious  hemorrhage  from 
the  bowel,  rendered  more  than  usually  dangerous  by  the 
abnormal  fluidity  of  the  blood,  is  not  an  infrequent  cause 
of  death;,  while  sudden  and  violent  bleeding  from  the  nose 
may  be  fatal  ere  help  can  arrive.  Several  years  often 
elapse  ere  the  patient's  health  is  comj^letely  restored,  and 
during  this  period  the  risks  of  an  attack  of  consumption 
are  always  great. 

Typhoid  fever  is  known  under  various  names,  in  every 
country,  while  in  certain  towns  or  portions  of  towns  it  is, 
owing  to  faulty  drainage,  endemic,  attacking,  as  do  all 
fevers,  most  readily  the  new-comers.  The  2')ulse  in  ty- 
phoid is  rarely  very  rapid ;  its  rate,  in  mild  cases,  may 
even  be  normal  during  the  greater  part  of  each  day. 

Typhus  Fever. 

Caused  hy  a  micro-organism  bred  by  overcrowding,  ac- 
cumulations of  filth,  and  other  grossly  unsanitary  condi- 
tions, and  propagated  readily  both  by  the  air  and  by  solid 
and  liquid  articles  of  food. 

Characterized  hy : 

(1)  A  stage  of  incubation,  marked  sometimes  by  head- 
ache, deafness,  and  imsteadiness  of  gait,  but  often  by  none 
of  these  discomforts. 

(2)  A  stage  of  invasioii,  lasting  three  or  four  days,  the 
commencement  of  which  is  indicated  by  the  sudden  acces- 


TYPHUS    FEVEE.  '  357^ 

sloa  of  severe  chills,  vomiting,  intolerable  general  headache, 
a  marked  contraction  of  the  pupils,  d,  flashed  face,  a  rapid 
and  fidl  pulse,  a  rapidly  rising  fever  showing  no  morning 
abatement,  and  often  great  disturbance  of  the  nervous  sys- 
tem, whicli  sometimes  takes  the  form  of  depression,  some- 
times of  excitement. 

(3)  A  stage  of  advance,  lasting  about  ten  days,  and 
marked  throughout  by  high  fever,  a  qidch  pulse,  contract- 
ed pupils,  great  restlessness,  and  maniacal  excitement,  con- 
stijxition,  and  by  a  copious  inidherry-hued  rash,  not  unlike 
that  of  severe  measles,  but  deeper  in  color,  more  persist- 
ent, and  tending  to  run  into  large  patches  and  to  be  inter- 
mingled with  peculiar  hruise-liJce  spots  (jt>e^ec/ieVe)  due  to 
extraA^asations  of  blood  under  the  skin. 

JRemarJcs. — Jail  fever  and  ship  fever  were  forms  of 
typhus,  as  were  also  the  Black  Plague  and  the  Black 
Death,  so  called  from  the  peculiar  darkness  of  the  erup- 
tion, the  frequency  of  the  bruise-like  extravasations  of 
blood,  and  the  color  of  the  vomit,  blackened  by  blood 
effused  into  the  stomach — for  both  in  typhus  and  typhoid 
is  there,  from  the  alterations  in  the  blood,  a  strong  ten- 
dency to  hemorrhage.  In  these  very  severe  forms  of 
typhus  the  lymphatic  system  became,  as  in  malignant 
scarlet  fever,  much  affected,  and  the  swelling  of  the  lym- 
phatic glands  of  the  body  gave  rise  to  those  swellings, 
called  plague  buboes,  which  formed  a  marked  character 
of  the  disease.  Like  scarlet  fever,  typhus  is  usually  con- 
tagious in  proportion  to  its  severity. 

While  the  general  dissimilarity,  except  in  name,  be- 
tween typhoid  and  typhus  seems  marked,  it  cannot  be 
doubted  by  those  who  have  seen  much  of  both  fevers, 
that,  occasionall}^  there  seems  to  exist  a  close  relationship 
between  them.  When  engaged  in  studying  fever  in  the 
East-End  slums  of  London,  I  have,  over  and  over  again. 


358  DISOKDEES    OF    THE    BLOOD. 

seen  isolated  cases  of  typhus  apjiear  in  the  midst  of  a 
typhoid  epidemic,  and  even  the  characteristic  rash  and 
symptoms  of  typhus  replace  the  last  stages  of  what  had, 
to  all  appearance,  previously  been  a  typical  tyj^hoid  fever. 
Typhus  has  become,  in  modern  times,  a  comparatively 
rare  European  disorder. 

Famine  Fever  (sometimes  called  Relapsing  Fe-cer). 

Caused  by  a  micro-organism,  developed  under  certain 
conditions,  the  j^rincipal  of  which  are  destitution  and  dirt. 
Characterized  by : 

(1)  A  stage  of  incubation,  with  no  symj^toms. 

(2)  A  stage  of  invasion  and  advance,  lasting  for  about 
five  days,  and  marked  by  high  fever,  vomiting,  and  pain 
in  the  back,  and  sometimes  by  slight  jaundice  and  bruise- 
like spots,  but  by  no  rash. 

(3)  A  stage  of  recovery,  which  sets  in  promptly,  and  is 
often  ushered  in  by  copious  perspiration. 

(4)  A  stage  of  relapse,  during  which  for  a  few  days  the 
fever  returns. 

It  results  nearly  always  in  recovery. 
Remarks, — It  aj^pears  only  as  an  epidemic  in  times  of 
great  and  widespread  want. 

Yellow  Fever. 

Caused  by  a  micro-organism,  develojDed  under  certain 
unknown  conditions,  but  those  in  which  a  prolonged  high 
temperature  and  the  presence  of  much  moisture  seem  es- 
sentials. 

Characterized  by  an  abrupt  commencement  of  all  the 
general  signs  of  fever,  to  which  are  added  severe  head- 
ache, urgent  vomiting,  the  vomit  being  often  black  from 
effusion  of  blood  into  the  stomach,  aching  of  limbs  and  of 
back,  gvQSii  irritability  of  stomach,  the  passage  of  dark  red 


YELLOW    FEYEE,   DENGUE,   AND    SMALL-POX.  359 

or  of  almost  blacJc  urine,  slight  jaundice,  delirium,  and 
great  mental  anxiety.  At  the  end  of  two  or  three  days 
these  symptoms  generally  subside,  and  recovery  may 
take  place,  but,  more  generally,  this  improvement  is  but 
of  short  duration,  and  is  succeeded  by  a  return,  in  a  much 
aggravated  form,  of  all  the  symptoms,  which  then  end  in 
death. 

RemarTiS. — The  mortality  of  yellow  fever  varies  with 
the  race  and  with  the  nature  of  the  epidemic.  Xegroes 
are  rarely  attacked,  and  then,  as  a  rule,  but  mildly;  the 
natives  suffer  much  less  from  the  disease  than  do  the  more 
recent  arrivals.  In  bad  epidemics  the  mortality  is  some- 
times as  high  as  one  in  three. 

Dengue  (Dandy  or  Breakbone  Fever.) 

Caused  hy  a  micro-organism. 

Characterized  hy  a  sudden  onset  of  chills,  followed  by 
fever,  with  headache,  nausea,  and  intense  pain  and  swell- 
ing of  all  the  joints,  and  by  the  appearance,  on  about  the 
third  day,  of  a  peculiar  rash  on  the  p)cdms  of  the  hands, 
which  itches  intensely  and  spreads  rapidly  over  the  ichole 
body.     The  fever  present  is  of  a  remittent  character. 

JRemarlcs. — The  dengue  occurs  only  in  tropical  coun- 
tries, and  as  an  epidemic.  Though  an  exceedingly  pain- 
ful, it  is  but  seldom  a  fatal,  affection,  and  rarely  lasts 
longer  than  a  week.  Convalescence  is,  however,  often 
slow. 

Small-pox. 

Caused  hy  a  micro-organism  capable  of  transmission  by 

arr,  liquids,  or  solids. 

Characterized  hy  the  following  well-defined  stages: 

(1)  A  stage  of  incxdyation,  lasting  from  ten  to  fourteen 

days,  and  marked  by  no  distinct  symptoms. 


360  DISORDEKS    OF    THE    BLOOD. 

(2)  A  stage  of  invasion,  lasting  two  or  three  clays, 
marked  chiefly  by  intractable  sickness,  severe  headache, 
ana  fever. 

(3)  A  stage  of  advance,  marked  during  the  first  four 
or  five  days  by  a  subsidence  of  the  fever  and  the  gradual 
appearance,yj?'s^  on  the  forehead  and  face,  and  then  on  the 
trunk  and  extremities,  of  an  elevated  eruption  of  pimples 
which  steadily  increase  in  size  till  matter  is  formed  in  the 
apex  of  each.  This  maturation  occurs  on  or  about  the 
fifth  day  of  this  stage,  and,  coincidently  with  it,  the  fever 
rises  for  two  or  three  days,  at  the  end  of  which  time  the 
pimples  burst  and  discharge  matter  which  dries  and  forms 
crusts. 

(4)  A  stage  of  subsidence,  ending  in  recovery,  during 
which  the  scabs  fall,  leaving  scars. 

Resulting,  in  those  protected  by  vaccination,  generally 
in  recovery;  in  others,  especially  in  the  black  races,  very 
frequently  in  death. 

Remarks. — A  blood  poison,  such  as  that  of  small-pox, 
Av^hich  expends  its  violence  so  largely  on  the  skin  of  the 
body,  may  be  safely  predicted  to  be  dangerous  in  propor- 
tion to  the  extent  of  the  inflammation  it  produces,  for  the 
functions  of  the  skin  are  so  important  that  grave  mischief 
must  always  accompany  an  extensive  interference  with 
them.  Accordino;  to  the  abundance  and  the  closeness  of 
the  rash  is  therefore  always  the  danger.  The  evidences 
of  such  danger  will  moreover  be  rationally  sought  in  or- 
gans similar  in  function  to  the  skin,  and  on  which  the 
greatest  strain  must,  when  the  skin  function  is  in  abey- 
ance, most  naturally  fall.  These  are  the  lungs  and  kid- 
neys, pneumonia,  bronchitis,  and  acute  kidney  mischief 
being  the  forms  which  the  complications  generally  assume. 
As  in  all  fevers,  however,  the  blood  poison  may  itself  be 
so  virulent  and  abundant  as  to  destroy  life  within  the  first 


THE    QUESTION    OF    VACCINATION.  361 

few  hours  of  an  attack,  and  even  before  the  skin  has  had 
time  to  become  affected. 

The  Question  of  Vaccination. 

I  have  always  found  it,  and  still  find  it,  difficult  to  be- 
lieve that  any  one  who  has  been  actively  engaged  in  the 
capacity  of  a  medical  man,  during  an  epidemic  of  small- 
pox, can  honestly  doubt  that  efficient  vaccination  is  an 
almost  certain  preventative  of  the  disease.  I  am,  there- 
fore, a  tirm  believer  in  the  efficacy  of  vaccination.  To  up- 
hold universal  and  compulsory  infant  vaccination  is,  how- 
ever, another  and  very  different  matter,  and  one  to  which 
I  am  certainly  opposed,  and  that  on  the  following  grounds: 
Firstly,  because  it  has  never  been  proved  that  the  mild- 
ness of  modern  epidemics  of  small-pox  is  traceable  solely, 
as  has  been  ofttimes  stated,  to  the  influence  of  vaccination; 
nearly  all  febrile  diseases  tending  after  a  time  to  assume 
milder  forms.  Secondly,  because  it  is  irrational  to  bestow, 
compulsorily  at  any  rate,  on  every  child,  a  disease,  such  as 
is  vaccine-pox,  which,  though  undoubtedly  mild,  is  not 
without  both  temporary  and  permanent  influence  on  the 
health  of  the  body — for  it  must  have  some  permanent  in- 
fluence if  permanently  protective — in  view  of  the  fact 
that,  even  in  pre-vaccination  days,  not  more  than  one  in 
fifty  of  the  inhabitants  of  these  isles  was  attacked  by  the 
disease  ;  and  in  this  connection  it  behooves  us  further- 
more to  remember  that,  spite  of  the  universal  applica- 
tion by  law  of  vaccine-pox,  the  complaint  for  which  it  is 
a  substitute  has  by  no  means  been  wholly  banished  from 
the  land.  Thirdly,  because  vaccination,  while  practically 
universal,  is  not  unfrequently  inefficiently  performed,  or 
fails  to  protect  completely  because  not  often  enough  re- 
peated— in  short,  because  the  stamp  left  on  the  body  by 
ordinary  vaccination  in  childhood,  deep  as  it  is,  is  yet  not 
16 


362  DISORDERS    OF    THE    BLOOD. 

deep  enough.  Fourthly,  because  the  mortality  from  all 
the  epidemic  and  other  fevers  combined  has  not  actually 
fallen  since  vaccination  was  introduced,  or,  if  we  admit 
with  some  statisticians,  that  a  slight  fall  has  occurred,  not 
more  than  can  easily  be  accounted  for  by  improved  meas- 
ures for  the  detection  and  arrest  of  epidemics  and  for  the 
treatment  of  the  sufferer.  And  even  if  we  could  banish 
forever  the  fevers  from  our  midst,  as  long  as  men  are 
herded  together,  and  the  population  of  already  over- 
crowded countries  is  allowed  recklessly  to  increase,  so 
long  must  and  will  a  high  mortality  be  maintained,  while 
of  the  three  means  by  which  over-population  is  kej^t  in 
check — war,  want,  and  pestilence — the  latter  is,  as  regards 
the  good  of  the  race,  not  unfrequently  the  best  for  human- 
ity, since  it  picks  off  generally  the  least  healthy — those 
least  able  to  equilibrate  under  difficult  conditions;  while 
want  often  tells  disastrously  both  on  the  sound  and  the 
weak ;  and  war  selects,  by  preference,  for  its  victims,  the 
prime  specimens  of  humanity. 

Did  space  permit  I  could  easily  supply  many  more  co- 
gent reasons  against  the  compulsory  and  inefficient  vacci- 
nation as  carried  out  in  England,  but  I  have  already  said 
sufficient  to  support  the  conclusion  to  which  personally  I 
have  long  since  arrived,  that  the  power  of  efficient  vacci- 
nation to  avert  small-pox  is  so  absolutely  certain  that  the 
element  of  compulsion  can  but  injure  its  recognition,  by 
leading  first  of  all  very  frequently  to  its  inefficient  per- 
formance, and  by  raising  a  suspicion  as  to  its  real  utility 
in  the  minds  of  people  who  see  it  so  greedy  of  extrane- 
ous support. 

Chicken-pox. 

Caused  by  a  micro-organism. 

Characterized  by  about  twenty-four  hours  of  mild  fever 
and  then  b}'^  the  sudden  commencement,  on  the  second  day, 


CHICKEX-POX,   EEMITTENT    FEVEE,   AND    AGUE.       363 

of  an  eruption,  which  may  begin  anyivhere  on  the  surface 
of  the  body,  of  red  pimples  which  in  three  or  four  days 
become  crowned  with  a  minute  vesicle  of  clear  fluid  (hence 
the  term  glass-pox)  which  is  discharged  and  leaves  a  crust, 
but  little  or  no  scar,  behind.  The  eruption  generally  comes 
out  in  successive  crops,  not  all  at  once  as  in  small-pox. 

Resulting  in  recovery. 

JRernarks. — It  is  not  by  any  means  always  easy  to  de- 
termine the  difference  between  mild  small-pox  and  severe 
chicken-pox. 

On  the  special  characters  of  the  former  which  I  have 
italicized  must  the  decision  be  largely  based. 

Remittent  Fever. 

Caused  by  a  micro-organism  bred  in  marshy  districts. 

Characterized  by  all  the  symptoms  of  intermittent  fever 
to  be  presently  described,  with  the  exception  that,  in  re- 
mittent fever,  the  febrile  condition  abates — but  never  van- 
ishes, as  in  the  intermittent  form— during  regular  intervals 
in  the  course  of  the  attack. 

Resulting,  as  does  the  intermittent  form,  often  in  par- 
tial, rarely  in  complete,  recovery,  and  sometimes  in  death. 

Intermittent  Fever  or  Ague. 

Caused  by  a  micro-organism,  developed  in  marshy  dis- 
tricts. 

Characterized  by  certain  well-marked  stages  : 

(1)  The  cold  stage,  which  commences  with  severe  shiv- 
ering extending  over  the  whole  body,  and  usually  to  the 
extent  of  teeth-chattering.  Though  the  sufferer  complains 
of  intense  cold,  the  bodily  temperature  is  actually  raised — 
^.  e.,  fever  is  really  present,  during  this  stage,  which  lasts 
from  half  an  Hour  up  to  three  or  four  hours. 

(2)  The  h.ot  stage.  —  This  follows  immediately  on  the. 


364  DISORDERS    OF    THE    BLOOD. 

first  stage  and  lasts  from  three  to  twelve  hours.  During 
its  continuance  the  sufferer  has  all  the  symptoms  of  a  high 
fever. 

(3)  The  sweating  stage. — This  succeeds  the  hot  stage 
and  lasts  a  few  hours,  ending  in  complete  relief. 

Hesulting.,  rarely  directly  in  death,  but  tending,  unless 
the  patient  removes  promptly  from  the  malarious  situa- 
tion, to  frequent  recurrence  and  permanent  ill-health. 

Remarhs. — The  type  of  fever,  determined  by  the  inter- 
val of  perfect  health,  is  variously  named.  Thus  when 
every  day  at  a  fixed  hour  the  shivering  sets  in,  the  ague 
is  said  to  be  a  quotidian ;  when  every  second  day,  it  is 
called  a  tertian ;  when  every  third  day,  it  is  said  to  be  a 
quartan  ague. 

Intermittent  fever  covers,  by  a  single  term,  a  vast  num- 
ber of  malarious  fevers,  some  of  much  greater  severity 
than  others,  but  always  marked  by  the  same  three  stages. 
They  are  all  endemic,  but  none  are  transferable  from  indi- 
vidual to  individual. 

The  place  of  attack  selected  by  the  micro-organism  of 
ague  seems  to  be  some  portion  of  the  stomach  or  bowel,  for 
both  its  temporary  results  and  its  permanent  after-effects 
are  restricted  to  the  abdominal  cavity,  and  almost  solely 
to  two  organs  situated  therein,  the  liver  and  the  spleen. 

Some  years  ago  the  writer  advanced  a  theory  to  account 
for  the  periodicity  of  the  attacks — namely,  that  the  micro- 
organism was  absorbed  by  the  bowel,  and  on  reaching  the 
liver  set  up  therein  a  disturbance  of  which  the  shivering, 
heat,  and  sweating  were  symptoms  ;  that  its  ejection  back 
into  the  bowel  with  the  bile  led  to  the  cessation  of  the  fe- 
ver, and  its  reabsorption  again  by  the  bowel  to  a  recur- 
rence of  the  attack.  That  swelling  of  tlie  liver  marks  the 
attacks,  that  a  return  to  its  natural  size  is  coincident  with 
its  cessation,  and  that  purgatives  have  a  markedly  cura- 


EPIDEMIC    MEXIXGITIS    AND    CHOLERA.  365 

tive  effect  in  this  fever,  are  three  points  universally  con- 
ceded, and  are  those  upon  which  the  theory  is  mainly 
founded. 

Oft-repeated  attacks  of  ague  lead  to  permanent  enlarge- 
ment of  the  liver  and  spleen,  and  to  a  corresponding  im- 
pairment of  their  functions. 

Cinchona-bark  and  its  derivative  quinine,  have,  it  is  well 
known,  a  remarkable  power  in  checking  and  preventing 
ague,  being  probably  destructive  of  the  micro-organism. 
Trarbu)'g''s  Fever  Tincture^  a  combination  of  cinchona-bark 
with  aperients  and  carminatives,  is  a  singularly  good  prep- 
aration. When  the  functions  of  the  spleen  have  been 
gravely  impaired  by  repeated  attacks  the  blood  is  apt  to 
become  much  impoverished  (the  spleen  being  a  blood- 
forming  gland),  which  state  of  matters  iron  and  arsenic 
seem  to  possess  the  power  of  improving. 

Epidemic  Cerebro-spinal  Meningitis. 

Caused  by  an  unknown  micro-organism. 

Characterized,  first  by  rigidity  of  the  head  and  nech, 
shivering,  lorostration,  and  then  by  extension  of  pain  over 
the  li'hoU  body,  the  appearance  of  a  peculiar  typhiis-lilie 
eruption  ;  these  symptoms  often  being  quickly  followed 
by  convulsions,  suppression  of  urine,  insensibility,  and 
death. 

JResidting,  most  frequently,  in  death ;  rarely  in  complete 
recovery. 

HemarJcs. — This  fever  is  an  exceedingly  rare  one,  ap- 
pears always  as  an  epidemic,  and  is  probably  not  con- 
tagious. 

Cholera  {Asiatic  Form). 

Caused  hy  a  micro-organism. 

Characterized  by  three  well-marked  stages  : 

First  stage — that  of  incubation — daring  which  the  com- 


366  DISORDERS    OF    THE    BLOOD. 

monest  symptoms  are  nausea  and  copious,  frequent,  but 
painless  purging.  This  stage  may  last  two  or  three  days, 
but  its  duration  is  usually  limited  to  three  or  four  hours. 

The  second  stage — that  of  attack  and  advance — suddenly 
replaces  the  first.  The  character  of  the  stools  now  alters 
from  that  of  an  ordinary  bilious  character  to  that  of  the 
peculiar  consistence  and  hue  of  rice  water.  The  kidneys 
cease  to  act.  Cramps  commencing  in  the  abdomen  spread 
to  the  muscles  of  the  extremities,  causing  horrible  contor- 
tions of  the  body.  The  face  and  the  whole  surface  of  the 
body  become  dry,  muddy -looking,  and  wrinkled ;  the  body 
of  the  sufferer  seems  to  have  visibly  shrivelled  and  grown 
smaller.  The  voice  becomes  feeble  and  whispering,  and 
the  pupils  closely  contracted.  The  intellect,  however,  is 
clear. 

Third  stage. — The  advent  of  the  third  stage — when  the 
sufferer  has  survived  the  second  or  collapse  stage — is  ush- 
ered in  by  an  apparent  all  -  round  improvement.  The 
stools  lessen  in  frequency,  the  pulse  returns  to  the  wrist, 
the  temperature  of  the  body,  hitherto  subnormal,  rises, 
and  the  cramps  become  less  severe.  In  some  cases  this 
improvement  is  maintained;  in  the  majority  of  instances, 
however,  the  suppression  of  urine  continues,  and  this  lat- 
ter paralysis  of  function  is  probably  the  greatest  factor  in 
the  production  of  the  successive  symptoms  of  headache, 
droicsiness^  convidsions,  and  com,a  which  ensue,  and  which 
nearly  always  terminate  in  death. 

Remarks. — The  best  authorities  seem  of  accord  as  to  the 
non-communicability  of  Asiatic  cholera  by  the  breath  or 
by  contact.  Both  the  vomit  and  the  dejecta,  however, 
contain  myriads  of  the  special  cholera  micro-organism, 
and  probabl}^  some,  but  certainly  not  many,  may  thus  be- 
come diffused  in  the  air ;  the  great  carriers  of  cholera  be- 
ing fluids,  and  especially  drinking-Avater.     This  cholera. 


CHOLERA.  36*7 

while  one  of  the  most  terrible  of  epidemic  fevers,  is,  at 
the  same  time,  the  one  that,  with  care,  can  most  easily  of 
all  be  avoided. 

Irregularities  of  diet,  intemperance,  exposure,  and  ex- 
haustion seem  to  predispose  to  the  disease. 

Of  the  special  plans  of  treatment,  and  they  are  many 
and  diverse,  recommended  in  cholera,  that  by  small  and 
oft-repeated  doses  of  castor  oil  is,  as  statistics  show,  and 
as  indeed  one  might  have  predicted,  the  best. 

The  intense  drain  of  water  and  salt  from  the  body,  for 
the  rice-water  evacuations  contain  an  abundance  of  com- 
mon salt  drawn  from  the  blood,  is  undoubtedly  one  of  the 
great  secondary  dangers  to  be  feared,  and  is  oft  to  be  ad- 
equately met  by  the  injection  into  the  veins  of  these  sub- 
stances. The  improvement  which  almost  immediately 
ensues  on  this  artificial  restitution  to  the  blood-current  of 
these  important  constituents  is  remarkable,  but  the  drain- 
age away  of  them  is,  especially  in  the  second  stage  of  the 
malady,  so  rapid  that,  to  be  really  efficacious,  such  injec- 
tions must  be  frequently  repeated. 

Cholera  {English  Form), 

Caused^  probably,  by  some  micro-organism  akin  to  that 
of  Asiatic  cholera,  but,  on  account  of  the  comparatively 
low  maximum  summer  temperature  of  Great  Britain, 
never  developing  sufficiently  to  constitute  an  equally  vio- 
lent poison. 

Characterized  hy  two  stages  : 

First  stage  -that  of  incubation — often  lasting  but  a  few 
hours,  and  marked  by  sichiess,  fever,  and  ordinary  diar- 
rhoea. 

Second  stage — that  of  advance — during  which  \}s\q  jyurg- 
ing  becomes  exceedingly  frequent,  the  stools  containing 
much  w^ater  and  often  an  abnormal  amount  of  common 


368  DISORDERS    OF    THE    BLOOD. 

salt,  but  being  never  of  the  rice-water  character.  Cramps 
in  the  abdomen  are  frequent  and  severe,  and  sometimes 
extend  to  the  extremities.  The  functions  of  the  kidney 
are  impaired.  The  skin  shrivels,  the  face  becomes  con- 
tracted^ and  the  complexion  niuddydooking.  In  children 
convulsions  are  often  witnessed,  and  are  always  an  indica- 
tion that  the  disease  is  likely  to  prove  fatal.  In  fatal 
cases,  inse7isibility  sets  in  towards  the  end. 

Remarks. — This  disease,  known  also  as  epidemic  sum- 
mer diarrhoea,  is  one  of  the  greatest  scourges  of  infancy. 
It  commences  usually  in  July  and  lasts  during  the  re- 
mainder of  the  summer  heat,  the  epidemic  declining  al- 
ways with  a  fall  in  the  temperature.  Children  are  far 
more  prone  than  are  adults  to  the  attack,  but  those  of 
them  who  draw  their  nourishment  exclusively  from  ma- 
ternal breasts  are  singularly  free.  In  the  young  the  at- 
tack is  often  of  a  fortnight's  duration,  and  the  convales- 
cent period  which  ensues  may  last  even  longer.  As  in 
Asiatic  cholera,  treatment  by  means  of  mild  purgatives, 
rhubarb  or  castor  oil,  is  by  far  the  most  eiiicacious,  while 
ordinary  salt  and  bicarbonate  of  sodium  may  also  w'ith 
advantage  be  freely  administered  to  counteract  the  drain 
from  the  body  of  the  sodium  compounds.  In  adults  the 
disease  runs  a  short  but  sharp  course,  a  copious  dose  of 
castor  oil,  followed  sometimes  by  a  few  doses  of  diluted 
sulphuric  acid,  combined,  if  need  be,  with  a  little  chloro- 
dyne,  usually  sufficing  to  restore  the  sufferer  rapidly  to 
comfort.  In  the  aged,  w^hile  the  same  course  of  treatment 
is  generally  successful,  death  may  result  from  the  prostra- 
tion which  accompanies  the  profuse  diarrhoea  or  from  the 
intensity  of  the  abdominal  pains. 

Diphtheria  and  Croup. 
To  the  student  versed  in  the  lore  of  the  shorter  mcdi- 


DIPHTHERIA    AND    CROUP.  369 

cine-made-easy  treatises,  the  above  conjunction  of  what  he 
has  been  taught  to  regard  as  two  distinct  diseases  will  ap- 
pear heterodox. 

But  the  ordinary  classification,  founded  as  it  is  mainly 
upon  the  contrast  often  presented  between  the  symptoms 
observed  in  cases  of  diphtheria  that  attack  mainly  the 
windpipe  and  the  larynx,  and  called  membranous  croup, 
and  those  of  other  instances  of  the  same  disease  in  which 
the  higher  regions  of  the  throat  alone  bear  the  brunt,  can- 
not hold  its  ground ;  for  such  an  argument  would  tell 
with  even  greater  force  for  the  severance  of  two  common 
sub-varieties  of  diphtheria — the  endemic  and  the  epidemic 
• — which  present  in  their  course  and  their  fatality  even 
greater  divergence. 

The  fact  of  the  matter  is,  that  diphtheria,  like  scarlet 
fever,  may  exhibit  various  degrees  of  virulence,  and,  like 
Asiatic  cholera,  may  exist  in  an  endemic  and  scarcely 
dreaded  form,  or  in  the  epidemic  and  most  terrifying 
shape. 

Diplitlieria  is  caused  hy  a  micro-organism,  often  of  little 
virulence  when  developed  in  damp,  clayey  soils,  rich  in  de- 
caying vegetable  matter,  and  endemic  in  its  character,  but 
of  great  power  for  evil  when  originating  in  connection  with 
animal  excreta  from  which  air  has  been  largely  excluded 
and  of  the  epidemic  or  the  sporadic  kind. 

Characterized  hy  two  stages  : 

First  stage  —  that  of  incubation  —  lasting  probably  not 
more,  in  the  majority  of  cases,  than  twenty-four  to  forty- 
eight  hours,  and  marked  sometimes  by  no  symptoms,  but 
often  by  considerable  nervous  prostration. 

Second  stage — that  of  attach  and  advance. — The  advent 

is  very  sudden^  and  marked,  in  nine  tenths  of  the  cases,  by 

chills,  aching  of  the  limbs,  severe  and  characteristic  pain 

in  the  small   of  the  back,  and  extreme  prostration.     To 

16* 


370  DISORDERS    OF    THE    BLOOD. 

these  usually  succeeds  sore  throat,  often  but  little,  and 
sometimes  not  at  all,  complained  of.  The  appearance  of 
the  throat  is  characteristic.  The  tonsils  are  swelled,  and 
on  them,  and  sometimes  all  over  the  throat,  are  seen 
patches  of  what  looks  like  dirty  white  blotting-paper,  the 
characteristic  diphtheritic  membrane.  If  the  attack  be 
violent,  the  glands  at  the  angle  of  the  jaw  will  commence 
to  swell,  and,  as  in  scarlet  fever,  in  proportion  to  this  swell- 
ing will  the  disease  often  be  found  to  be  dangerous.  Ac- 
companying these  symptoms  there  is  an  extreme  and  char- 
acteristic prostration,  the  perspiration  often  streaming 
profusely  from  the  face,  and  the  patient  complaining  of 
extreme  faintness  and  inability  to  sit  up.  The  tempera- 
ture of  the  body  will,  as  in  cholera,  be  found  often  to  be 
subnormal,  remaining  for  days  at  97°  F.,  or  even  96°  F. 
The  heart's  action  is  feeble,  and  sometimes  irregular.  The 
functions  of  the  kidneys  are  often  partly  arrested,  the 
urine  containing  much  albumen,  and  the  perspiration  of 
the  body  having  a  peculiar  urinous  smell. 

In  mild  cases  this  stage  does  not  last  more  than  two  or 
three  days,  though  even  then  recovery  from  the  extreme 
prostration  is  exceedingly  slow.  In  severe  cases  death 
from  paralysis  of  the  heart  or  lungs  is  common  during 
this  stage,  which  may  extend  for  a  week  or  a  fortnight ; 
while,  when  recovery  occurs,  the  subsequent  convalescence 
is  apt  to  be  a  matter  of  weeks  or  months,  or  even  of  years. 
Chronic  disease  of  the  kidneys  or  permanent  debility  of 
the  nervous  system  may  be  set  up  as  a  consequence  of  the 
disease. 

Hemarks. — Epidemic  dip>htheria  often  commences  in  a 
country-house  drained  into  a  cesspool.  It  spreads  rapidly, 
especially  by  means  of  fluids,  such  as  milk  or  water.  It 
has  a  high  mortality,  killing  from  50  per  cent.,  upwards, 
of  its  victims.     The  glands  of  the  neck  are  always  en- 


WHOOPING-COUGH.  371 

larged.  The  membrane  extends  rapidly  down  the  wind- 
pipe, often  even  into  the  lungs  ;  it  may  affect  the  surface 
of  the  eyes,  the  entire  inner  lining  of  the  nose,  and  be  some- 
times seen  covering  any  part  from  which  the  skin  has  been 
removed  —  as,  for  example,  by  a  blister.  Often  it  will 
spread  to  the  trachea  and  larynx  very  rapidly,  the  pre- 
ceding throat  mischief  escaping  notice.  When  children 
are  thus  attacked,  a  set  of  symptoms  known  as  those  of 
croup  ensue.  Epidemic  diphtheria  is  apt  to  be  compli- 
cated or  followed  by  a  series  of  paralytic  symptoms.  It 
is  highly  infectious. 

Endetnic  dij^htheria  prevails  over  large  districts  of  towns, 
especially  where  the  sub-soil  is  of  clay  and  the  houses  have 
been  built  on  made  soil  containing  much  animal  and  veg- 
etable refuse.  It  is  far  more  common  in  autumn,  winter, 
and  spring  than  in  summer.  The  attack  is  brief  but 
severe,  lasting  usually  from  two  to  five  days.  It  is  but 
rarely  fatal,  travels  by  milk  and  water,  but  is  certainly  not 
directly  transferable. 

In  connection  with  croup,  it  is  important  to  remember 
that  a  congestion  of  the  trachea  and  larynx  producing  all 
the  symptoms  of  diphtheritic  croup  is  not  uncommon, 
especially  as  a  first  symj^tom  in  measles.  This  is  a  sim- 
ple laryngitis  unaccompanied  by  any  membrane.  Again, 
spasm  of  the  glottis,  child-crowing  or  False  Croup,  a  com- 
mon reflex  symptom  in  children  during  the  period  of  teeth- 
ing, or  a  consequence  of  intestinal  worms,  generally  recur- 
rent and  but  rarely  fatal,  must  not  be  confounded  with  the 
exceedingly  dangerous  disease,  real  diphtheritic  croup. 

Whooping-cough. 
Caused  by  a  micro-organism  of  an  unknown  kind. 
Characterized  by  two  stages  : 

First  stage,  marked  by  the  symptoms  of  an  ordinary 
cold  and  by  a  cough,  which  is  usually  vwrse  at  night. 


372  DISORDERS    OF    THE    BLOOD. 

Second  stage,  the  cough  becomes  spasmodic  and  charac- 
teristic of  the  complaint.  In  the  intervals  between  the 
acts  of  coughing  —  if  no  complication  be  present  —  the 
sufferer  is  quite  well.  The  duration  of  this  stage  is  vari- 
able and  depends  largely  on  atmospheric  states,  rarely 
ceasing  as  long  as  the  weather  remains  damp  or  cold  ; 
hence  the  popular  idea  that  this  affection  does  not  get  well 
till  the  month  of  May. 

Resulting,  if  of  a  mild  and  uncomplicated  form,  such 
as  may  occasionally  be  seen  during  a  dry,  hot  season, 
almost  invariably  in  recovery ;  but  if  of  a  severe  type, 
and  the  sufferer  be  delicate  or  exposed  to  sudden  changes 
of  temperature,  often  in  complications  which  imperil 
life. 

Hemai'ks.— The  frequent  repetition  of  a  violent  cough 
such  as  is  that  of  whooping-cough,  constitutes  in  itself  a 
grave  danger.  The  strain  thrown  by  it  on  the  blood-ves- 
sels of  the  head  is  visible  in  the  swollen  and  turgid  face, 
the  bloodshot  eyes,  and  the  not  infrequent  bleed  big  from 
the  nose.  These  are  of  trifling  import,  but  the  pressure 
on  the  circulation  in  the  brain  is  of  a  serious  Mnd,  and  may 
even  end  in  an  effusion  of  serum  into  the  ventricles  of  that 
organ  and  thus  to  convulsions  and  death,  a  by  no  means 
uncommon  termination  of  the  disease.  The  violence  done 
to  the  lungs — w^hich  are  not  themselves,  primarily  at  any 
rate,  the  seat  of  disease  in  this  complaint — may  also  end 
in  severe  secondary  mischief,  of  wdiich  bronchitis,  chronic 
dilatation  of  the  bronchial  tubes  (i.  e.,  bronchiectasis),  or  of 
the  air-vesicles  {i.  e.,  ptdmonary  emphysema),  or  obstruc- 
tion of  some  one  or  more  of  the  bronchial  tubes,  leading  to 
collapse  of  a  portion  of  the  lung,  are  perhaps  the  com- 
monest ;  v;\n\Q  pleurisy  and  the  cajnllccry  variety  of  bron- 
chitis, both  very  formidable  complications,  may  also  be 
occasioned. 


TREATMENT  OF  THE  FEVERS.  373 

General  Principles  on  ichicJi  the  Treatment  of  the  Fevers, 
thus  far  described,  must  he  conducted. 

The  reader  will  consider  it  high  time  that  I  should  give 
some  directions  for  the  prevention  and  treatment,  if  not 
for  the  cure,  of  the  lono;-  list  of  blood  diseases  due  to  micro- 
organisms,  which  we  have  discussed. 

I  have  stated  somewhat  dogmatically  that  each  of  those 
complaints  is  caused  by  a  micro-organism,  a  fact  quite  be- 
yond dispute  in  some  cases,  and  in  every  case  advancing 
rapidly  to  actual  proof.*  Surely  if  this  be  so  the  treat- 
ment should  consist  in  findinsr  for  the  micro-oro-anism  a 
poison  which  can  be  absorbed  into  the  blood,  and  that  shall 
at  the  same  time  be  harmless  to  the  liost.  Now  we  pos- 
sess, in  point  of  fact,  a  goodly  array  of  such  substances, 
none  of  which,  however,  w^hen  introduced  into  the  vital 
stream,  has  any  effect  in  checking  the  advances  of  the 
fevers.  Why  is  this  ?  Probably  because  the  symptoms 
of  fever  are  rather  the  result  of  poisoning  from  the  disin- 
tegration of  albuminoids  dependent  on,  but  subsequent  to, 
the  fermentative  process  set  up  in  the  blood-stream  by  the 
micro-organisms,  than  the  phenomena  dependent  on  an 
active  struo^sile  between  micro-oro^anisms  and  livino^  cells. 

On  this  latter  theory  the  fermentation  would  take  place 
during  the  so-called  stage  of  incubation,  a  period  which, 
when  carefully  studied,  is  always  found  to  be  marked  by 
some  symptoms ;  the  poisoning  by  the  albuminoid  debris 
(in  any  case  violent  poisons)  corresponding  with  the  active 
stages  of  the  attack. 

*  The  reader  who  wishes  for  a  careful,  scientific,  and  full  explana- 
tion of  the  point  which  these  discoveries  have  now  reached  should 
read  the  Harveian  Oration,  delivered  in  October,  1888,  by  Dr.  Latham, 
than  whom  there  is  no  medical  authority  so  cautious,  impartial,  accu- 
rate, and  therewithal  so  philosophical. 


374  DISORDERS    OF    THE    BLOOD. 

AVhichever  theory  be  correct,  it  is  absolutely  certain  that, 
with  the  possible  exception  of  quinine  in  ague,  we  possess 
no  real  antidote  whatever  to  any  fever  poison. 

TJie  precautions  to  be  observed  in  the  avoidance  of  fever 
are  almost  too  well  known  to  need  mention.  The  general 
bodily  health  must  be  maintained,  for  it  is  true  of  at  least 
the  larger  number  of  fever  germs  tliat  they  have  little 
power  of  attacking  a  really  healthy  individual,  and  that 
such  a  one,  even  if  he  falls  a  victim,  stands  a  good  chance 
of  recovery.  Then  again  we  know,  as  a  general  truth, 
that  fever  germs  flourish  best  in  a  warm  atmosphere,  poor 
in  oxygen  but  rich  in  organic  particles  given  off  by  the 
bodies  of  men  and  animals.  Fresh,  dry  air  is  therefore  the 
best  of  preventatives,  and  the  avoidance  of  close  rooms 
and  densely  inhabited  parts  of  large  towns  is  imperative. 
There  is  no  proof  that  the  evil-smelling  disinfectants  so 
often  used  in  the  sick-rooms  of  the  fever-stricken,  and 
which  usually  inconvenience  and  sometimes  seriously  dis- 
turb them,  are  of  any  service  at  all. 

For  my  own  part,  I  simply  recommend  the  manufacture 
in  the  sick-room  of  ozone,  which  can  be  easily  carried  out, 
either  in  the  manner  recommended  by  Dr.  Fox  ("  Ozone 
and  Antozone,"  p.  25)  by  the  gradual  admixture  of  three 
parts  of  oil  of  vitriol  with  two  parts  of  permanganate  of 
potassium,  or  by  heating  a  platinum  wire  by  a  Bunsen  cell. 
Oxygen  water  may  also  be  freely  consumed. 

Undoubtedly  it  is  a  rational  thing  to  administer  an  effi- 
cient purge  at  the  very  earliest  date  at  which  the  existence 
of  a  fever  poison  in  the  body  is  suspected.  Of  all  purga- 
tives none  at  such  a  time  excels  calomel.  Two  to  five  grains 
of  this  substance  may  be  placed  at  night  on  the  tongue  of 
infant  or  adult,  and  followed  in  ten  hours  by  a  dose  of  some 
simple  saline.  In  the  commencement  of  typhoid  fever, 
typhus  fever,  scarlet  fever,  epidemic  roseola,  and  English 


TREATMENT  OF  THE  FEVERS.  375 

cliolera,  this  course  seems,  as  far  as  one  can  judge,  to  be 
followed  by  happy  results,  and  indeed  it  is  often  in  these 
complaints  advisable  to  rej)eat  the  dose  each  night  for 
three  or  four  times.  The  best  way  to  treat  the  nausea  and 
sickness,  such  an  early  and  oft-distressing  symptom  in  fever, 
is  to  encourage  it  by  administering,  every  three  or  four 
hours,  one  drop  of  ipecacuan  wine  in  a  wineglassful  of  very 
hot  water.  The  headache  is  also  most  readily  relieved  on 
the  same  paradoxical  lines,  hot  flannels  or  gentle  friction 
with  oil  of  cinnamon  beincr  more  serviceable  than  cold-water 
coils  or  ice-caps,  though,  when  the  headache  seriously  in- 
terferes with  sleep,  and  other  methods  fail,  the  latter  may 
be  given  a  trial. 

Once  under  way  I  do  not  think  that,  in  the  present  state 
of  our  knowledge,  it  is  justifiable  to  make  attempts  to 
arrest  the  fever.  Such  experiments  are  always  dangerous  to 
the  patient,  however  flattering  to  the  hopes  of  the  patient's 
friends.  I  know  the  difficulty  of  an  ''attitude  of  masterly 
inactivity  "  in  fever,  but  I  have  never  been  disappointed  in 
its  results,  nor  known  disapproval  of  the  course  expressed 
by  intelligent  people.  Remembering  the  very  narrow 
limits  within  which  absorption  by  the  bowel  in  fever  is 
possible,  it  is  always  advisable  to  see  that  the  intestine  is 
not  allowed  to  become  clogged  with  offensive  fermenting 
matter.  To  this  end  there  is  no  drug  equal  to  castor  oil, 
a  dessertspoonful  or  more  of  which,  mixed  with  15  grains 
of  bicarbonate  of  sodium,  and  administered  in  2  or  3  oz. 
of  peppermint  water,  forms  an  easily  taken  draught.  Even 
when,  as  may  happen  in  all  fevers,  and  does  occur  in  the 
vast  majority  of  cases  of  typhoid  fever,  diarrhoea  is2:)resent, 
a  teaspoonful  of  castor  oil  with  two  drops  of  the  oil  of 
eucalyptus,  given  once  or  twice  a  day,  usually  succeeds  far 
better  in  rectifying  efficiently  the  intestinal  irritation,  and 
thus  arresting  safely  the  flux,  than   do  astringents.     If, 


376  DISORDERS    OF    THE    BLOOD. 

however,  one  of  the  latter  class  must  be  administered, 
choice  should  be  made  of  the  mineral  acids  freely  watered, 
and  of  these  the  dilute  aromatic  sulphuric  acid  given  every 
four  or  six  hours  in  doses  of  fifteen  to  twenty  drops  in  an 
abundance  of  water  is  the  best,  according  to  my  experi- 
ence. A  daily  warm  bath,  where  this  can  be  tolerated,  or 
the  sponging  of  the  surface  of  the  body  twice  a  day  with 
tepid  water,  are  measures  always  useful,  except  in  cases  of 
measles  and  scarlet  fever  when,  with  severe  general  symp- 
toms, the  rash  is  scanty  and  its  retrocession  to  be  feared. 
When  the  throat  is  sore  there  is  no  such  comfort  to  be  ob- 
tained as  that  from  swallowing  ice,  and  I  have  seen  hun- 
dreds of  small- pox  cases  satisfactorily  treated  in  hospitals 
where  an  unlimited  allowance  of  ice  to  check  the  exas- 
perating soreness  of  the  throat  was  the  only  means  of 
treatment  adopted.  An  abundance  of  fluid  (^.  e.,  water) 
may  generally  be  permitted  in  fever.  It  has  the  effect  cer- 
tainly of  flushing  the  kidneys  without  acting  as  a  stimu- 
lant to  them,  and  it  furthermore  constitutes,  to  a  slight 
extent,  and  in  an  indirect  wa}^,  a  nourishment.  My  experi- 
ence is  that  the  less  a  fever  patient  is  drugged  the  greater 
is  his  chance  of  life,  but  that,  if  active  treatment  must  be 
undertaken,  it  should  be  on  the  lines  of  a  humble  and 
cautious  following  of  Nature  as  she  is  seen  w^orking  in 
the  symptoms  of  disease. 

Nursing  and  dieting  are  matters  in  fever  that  should, 
however,  always  engage  our  attention.  There  are  a  hun- 
dred little  ways  in  which  a  skilful  nurse  may  materially 
assist  in  the  recovery  of  the  patient.  On  the  question  of 
dieting  it  is  of  the  utmost  import  to  remember  that  denu- 
trition  and  disintegration,  not  assimilation  and  repair,  are 
the  bodily  processes  that  mark  all  fevers.  This  cannot  be 
altered.  You  may  supply  albuminous  foods  in  the  form 
of  light  soups,  especially  fish  and  cheese  soups,  and  such 


TREATMENT  OF  THE  FEVERS.  Sll 

albumen  will  be  useful,  not  because  it  can  repair  cell 
waste,  but  because  it,  like  all  albumen,  can  undergo  a  cer- 
tain slow  oxidation  in  the  body,  and.  thus  perhaps  save  the 
combustion  of  the  tissues.  Meat  essences  again  contain 
stimulating  properties  often  of  service.  They  should, 
however,  be  administered  very  sparingly  indeed,  or  the 
kidneys  will  suffer.  Where  the  loss  of  flesh  is  rapid,  alco- 
hol, in  very  S7nall  and  regular  doses,  is  of  the  greatest  ser- 
vice. A  teaspoonful  of  the  best  brandy  or  whiskey  every 
four  or  six  hours,  well  diluted,  answers  all  useful  purposes. 
Given  in  larger  doses  to  rouse  the  pulse  and  heart,  it  is  a 
dangerous  poison,  whipping  up  and  prematurely  exhaust- 
ing the  already  flagging  circulation.  Milk,  when  the 
stomach  is  not  too  gravely  deranged,  is  an  excellent  food, 
but  when  it  is  given  the  motions  must  be  carefully 
watched,  and  if  green  evacuations  and  undigested  curds 
are  seen  it  should  be  discontinued.  In  children  with 
fever  I  have  often  seen  violent  convulsions  ensue  from  the 
presence  in  the  intestine  of  these  hard  curds.  In  many 
bad  cases  coffee  and  tea  are  of  great  service  and  may  be 
freely  given.  Fats  are  rarely  tolerated,  but  are  useful  in 
the  exceptional  cases  in  which  they  agree,  butter  and 
cream  being  the  best  forms.  The  starches  are  badly 
borne  as  a  rule,  but  in  mild  fever,  well-cooked  farinaceous 
puddings,  without  eggs,  are  often  digested.  There  is  usu- 
ally present,  even  in  children,  an  instinctive  dislike  in 
fevers  to  anything  sweet,  but  an  effort  should  always  be 
made  to  coax  the  sufferer  to  take  grape-sugar  or  milk- 
sugar;  the  former  may  be  given  as  an  extract  of  malt, 
which  is  nearly  always  pure  grape-sugar  and  nothing  else 
— but,  as  such,  an  excellent  body  fuel — the  latter  in  the 
form  of  whey,  which  fluid  contains,  in  addition  to  milk- 
sugar,  many  highly  useful  salts.  Sour  buttermilk  is  often 
well  tolerated  in  fevers  and  is  a  useful   food.     In  mild 


378  DISORDERS    OF    THE    BLOOD. 

fevers,  if  diarrhoea  be  not  present,  grapes  may  be  allowed 
and  usually  agree  well.  Beverages  made  with  fresh 
fruits,  but  not  sweetened  with  cane-sugar,  are  certainly 
useful,  containing,  in  the  form  of  grape-sugar  and  various 
salts,  useful  nutriment.  Maigre  soups,  containing  only 
traces  of  solid  vegetables,  are  often  to  be  highly  com- 
mended. 

Such  are  the  general  rules  for  all  ordinary  attacks  of 
such  fevers  as  we  have  considered.  Complications  as 
they  arise  must  be  met  on  the  ordinary  principles;  firstly, 
by  trying  to  arrest  the  causes  of  their  production;  second- 
ly, by  gently  favoring  the  development  of  the  sj^mptoms. 

We  now  come  to  the  consideration  of  the  second  group 
of  fevers,  differing  from  the  ones  we  have  just  considered 
by  the  fact  that— with  the  exception  possibly  of  tubercu- 
losis and  of  some  milder  forms  of  erysipelas — these  latter 
are  communicable  only  by  inoculation,  and  not  by  waj^  of 
the  stomach  or  the  lungs  as  was  the  case  in  our  first  group. 

Syphilis. 

Caused  by  a  micro-organism. 

Characterized  hy  three  well-marked  stages: 

First  stage — that  of  incubation.  This  may  last  from 
ten  to  forty-six  days,  or  even  longer,  and  is  characterized 
by  no  definite  general  symptoms. 

Second  stage — tJiat  of  attack.  This  is  sometimes  called 
simply  "primar}^  syphilis,"  and  is  marked  by  the  appear- 
ance at  the  seat  of  inoculation  of  a  hard  but  commonly 
painless  excrescence  or  ulceration,  by  the  general  characters 
of  mild  fever,  shivering,  headache,  loss  of  appetite,  and 
general  malaise.  A  mild  sore  throat  is  also  generally 
present. 

This  period  may  last  from  a  couple  of  weeks  up  to  a 
month  or  more. 


SYPHILIS.  379 

Third  stage — called  "  secondary  sypJdlis  " — is  marked 
by  swelling  of  the  lymphatic  glands  in  the  neighborhood 
of  the  site  of  inoculation,  acute  sore  tJiroat,  an  eruption 
which  varies  much  in  character  and  severity,  but  which 
usually  is  of  a  faint  roseolous  hue,  and  general  symptoms 
of  fever  of  a  more  severe  type  than  those  witnessed  in  the 
earlier  stage.  Peculiar  superficial  ulcers,  like  snail  tracks, 
often  appear  on  the  tongue  and  gums,  and  larger  but  simi- 
lar patches  are  seen  commonly  on  the  throat.  Soft  warty 
outgrowths  and  fringes  (condylomata)  are  also  often  seen 
on  the  mucous  membranes  of  the  body. 

During  this  stage,  which  may  last  for  some  weeks  or 
months,  the  eye  is  not  unfrequently  attacked  by  various  in- 
flammatory symptoms,  of  which  iritis  is  the  most  common. 

Remarks.  —  With  the  termination  of  the  secondary 
symptoms  the  disease  may  finally  vanish.  At  any  rate  it 
then  ceases  as  a  fever,  and  is  no  longer  contagious,  but  in 
ihs  vast  majority  of  cases,  unless  the  standard  of  gen- 
eral health  is  well  maintained,  a  great  number  of  symp- 
toms, which  may  select  any  organ,  will  bear  evidence 
to  the  radical  mischief  done  to  the  body  by  this  fever. 
It  is  the  lymphatic  system  on  which  the  brunt  of  dis- 
ease falls,  and  therefore  in  syphilis,  as  in  scrofula,  it  is  in 
the  organs  of  that  system,  and  in  its  nearer  dependencies, 
that  the  evil  sequences  thereof  are  most  apparent.  Rheu- 
matism is  thus  a  common  sequel.  It  would  be  impossible 
to  attempt  an  enumeration  of  even  the  more  ordinary  de- 
generative consequences  of  this  disease,  so  various  are 
they.  The  brain,  the  spinal  cord,  the  bones,  the  lungs, 
the  heart,  the  liver,  the  spleen,  the  kidneys,  the  eyes,  the 
ears,  the  throat,  the  larynx,  the  skin  (very  frequently  in- 
deed) may  each  or  all  become,  on  the  least  decline  of 
health,  or  even  independently  of  that,  and  five,  ten,  fifteen, 
or  twenty  years  after  the  fever  has  ceased,  the  seat  of  dis- 


380  DISORDERS    OF    THE    BLOOD. 

organization.  Worse  still,  the  sufferer  will  transmit  his 
often  fatally  nndermined  system  to  his  offspring,  in  whom 
the  taint  will  appear  in  the  first  few  weeks  of  life,  and 
whose  whole  life  may  thereby  be  crippled  or  prematurely 
terminated. 

Treatment. — While  not  denying  for  a  moment  the  un- 
challengeable power  possessed  by  mercury  of  causing  the 
symptoms  of  primary  and  secondary  s^q^hilis  to  disappear, 
I  am  at  one  with  the  large  band  of  medical  men,  many  of 
them  eminent  specialists,  who  regard  the  administration 
of  this  mineral,  excej^t  temporarily  to  combat  some  grave 
and  advancing  lesion  of  an  important  organ,  as  a  mistake 
in  the  long  run. 

The  man  who  takes  the  salts  of  mercury  purchases  a 
large  immunity  from  the  troublesome,  but  rarely  danger- 
ous, symptoms  of  primary  and  secondary  syphilis,  at  the 
risk  of  the  permanent  ruin  of  his  health  and  of  grave  and 
often  fatal  after-consequences.  Patience,  and  the  adop- 
tion of  such  general  principles  of  treatment  as  I  have  in- 
dicated as  suitable  for  feverish  states,  should  at  least 
always  have  a  fair  trial  ere  mercury  is  resorted  to,  for  this 
mineral  can  always,  at  a  pinch, be  had  recourse  to.  Every 
means  and  method  that  can  maintain  a  high  state  of  health 
should  be  diligently  used.  In  the  treatment  of  such  se- 
quelae as  characterize  tertiary  syphilis,  the  iodides  of  po- 
tassium, sodium,  or  ammonium  are  often  useful,  but  more 
especially  in  cases  where  mercury  has  been  taken,  and  this 
fact  leads  us  strongly  to  susjoect  that  many  of  the  symp- 
toms of  tertiary  syphilis  are  due  to  the  mercury,  which 
the  iodides  can,  by  forming  with  it  soluble  salts,  expel 
from  the  sj^stem.  It  is  common  to  meet  men,  well  quali- 
fied to  judge,  who  bitterly  regret  ever  having  taken  a  long 
course  of  mercury;  but  it  is  exceedingly  rare  to  meet 
those  who  regret  not  having  had  recourse  to  it. 


TUBERCULOSIS.  381 

Tuberculosis  {Acute  General  Tuberculosis,  or  "  Gallopjnn^/ 

Consuinjjtion  "). 

Caused  hy  a  micro-organism. 

Characterized  by  two  stages: 

First  stage — that  of  incubation  —  is  of  very  uncertain 
duration,  and  marked  by  general  and  mild  symptoms  of 
derangement. 

Second  stage — that  of  invasion  and  advance — the  onset 
of  which  is  sudden,  tlie  duration  three  to  six  weeks,  and 
the  invariable  termination,  death.  The  symptoms  are 
none  of  them  characteristic,  and  the  diagnosis  is  therefore 
often  difficult.  The  fever  present  is  icorse  at  night,  but 
rarely  rises  above  103°  F.  The  patient  is  dull  and  apa- 
thetic; emaciating  and  losing  strength  very  rapidly.  The 
pulse  is  weak  and  rapid,  the  skin  dry  and  harsh,  and  the 
tongue  and  lips  parched  and  cracked.  The  bowels  may 
be  regular,  or  constipation  or  diarrhoea  may  be  present. 
Headache  is  often  much  complained  of,  and  towards  the 
end  delirium  is  usually  present.  There  is,  as  a  general 
rule,  no  rash,  but  sometimes  a  faint  roseolous  eruption  on 
the  abdomen  will  appear. 

Hemarks. — I  have  said  but  a  few  words  on  a  very  terri- 
ble disease,  for,  as  I  have  already  remarked,  tuberculosis 
presents  no  distinctive  marks  by  which  we  may  assure 
ourselves  of  its  presence.  In  fact,  it  usually  is  mistaken 
for  typhoid  fever,  Avhich  its  symptoms  often  very  closely 
imitate. 

That  certain  persons,  especially  the  scrofulous,  are  ex- 
ceedingly liable  to  be  attacked  by  this  disorder,  is  cer- 
tain, and  that  the  bacterium  may  develop  in  a  slowly  sup- 
purating lymphatic  gland,  situated  possibly  out  of  sight 
and  reach,  and  thus  infect  the  blood,  is  also  sure.  An 
ordinary  wound   may  also    serve    as   its  port   of   entry. 


382  DISOKDERS    OF    THE    BLOOD. 

Whether  a  sound  man  may  inhale  the  bacterium  of  tuber- 
culosis, and  thus  become  the   subject  of  the  malady,  is 

questionable. 

Erysipelas. 

Caused  by  a  micro-organism,  which  probably  can  only 
enter  the  blood  directly  through  a  broken  surface. 

Characterized  by  two  stages: 

First  stage — that  of  incubation — lasting  from  a  few 
hours  up  to  seven  days  or  longer,  and  marked  by  slight 
symptoms  of  malaise. 

Second  stage — that  of  advance — marked  by  shivering^ 
sore  throaty  fever^  and  general  constitutional  disturbance 
of  the  ordinary  febrile  type,  and  by  the  appearance,  first 
at  the  seat  of  inoculation,  if  there  be  one  visible,  and  then 
rapidly  spreading  therefrom  over  the  adjacent  skin,  of  a 
rash  of  a  deep  red  color,  the  reddened  skin  being  hot  and 
dry,  and  sometimes  swelled  and  painful  to  the  touch. 

Concurrently  with  tliese  symptoms,  there  may  arise 
cerebral  disturbance  from  the  extension  of  the  inflamma- 
tion to  the  membranes  of  the  brain,  or  broiicJiitis,  or 
vomiting,  or  diarrhoea,  from  its  extension  to  the  lining 
membranes  of  the  lungs,  stomach,  and  intestine  respect- 
ively. Its  subsidence  is  followed  by  "peeling"  of  the 
skin  attacked. 

liesulting  nearly  always  in  death  in  the  subjects  of 
diabetes  and  of  Bright's  disease,  who  are  also  specially 
prone  to  be  attacked;  almost  equally  dangerous  in  h'ing-in 
women,  in  drunkards,  and  in  those  who  have  recently  un- 
dergone severe  operations;  rarely  fatal,  except  in  its  most 
severe  forms,  in  others. 

Hemarks. — Like  so  many  of  the  other  results  of  blood- 
jioisoning,  er3'sipelas  varies  greatly  in  severity.  While 
most  authorities  liold  that  it  cannot  enter  the  body  but 
through  broken  skin,  it  is  undeniable  that  a  closely  simi- 


ERYSIPELAS.  383 

lar  dilfiiscd  redness  of  the  skin,  attended  with  mild  con- 
stitutional disturbance,  is  witnessed  often,  especially  in 
early  infancy,  though  the  cuticle  be,  to  all  appearances, 
w^hole. 

No  fever  is  so  generally  graded  in  its  severity  to  the 
state  of  health  of  the  person  attacked  as  is  erysipelas.  In 
the  heavy  drinker,  the  diabetic,  and  the  albuminuric,  the 
smallest  wound  may  become  the  seat  of  attack,  which  then 
spreads  far  and  wide.  Apparently  the  poison  germ  of 
this  disorder  may  be  bred  in  unhealthy  discharges,  for  in 
crowded,  close  hospitals,  especially  in  time  of  war,  erysip- 
elas will  often  make  its  appearance  and  lead  to  a  disas- 
trous mortality. 

To  give  the  reader  some  general  idea  of  the  varying 
nature  of  the  attacks,  all  equally  going  under  the  one 
name — erysipelas — I  append  a  short  classification. 

Non-contagious  Erysipelas,  ox  Erythema. — This,  though 
bearing  some  likeness  to  mild  erysipelas,  is  probably  due 
to  a  different  poison,  one  akin  to  that  which  produces 
epidemic  roseola. 

Ordinary  superficial  inflammation  of  the  skin,  the  result 
of  irritation,  is  also  often  improperly  styled  erysipelas. 
Both  of  these  transient  disorders,  called  by  the  French 
simply  ^''efflorescence  cutanee,''''  are  frequent  in  childhood. 
They  are  neither  epidemic  nor  contagious. 

Ordinary  Erysipelas. — Often  epidemic,  and  always  trans- 
ferable to  those  who  have  recent  vv^ounds.  This  is  the  type 
described  as  typical  erysipelas,  and  which  is  sometimes  fa- 
tal by  extension  to  the  brain,  etc. 

Phlegmonous  Erysipelas. — This  is  a  malignant  form  of 
the  disorder,  which  commences  in  the  upper  layers  of  the 
skin,  speedily  extends  to  the  tissues  beneath,  causing  their 
rapid  destruction,  and  leading  often  to  a  disintegration  even 
of  the  muscular  tissues,  with  exposure  of  the  bones,  and 


384  DISOEDEES    OF    THE    BLOOD. 

thus  to  death  by  exhaustion.  It  is  dangerous  in  propor- 
tion to  its  extent.  The  color  of  the  skin,  at  first  red, 
may  pass  to  a  livid  and  then  to  a  sickly  ichite,  tallowy 
hue. 

The  treatment  of  erysipehas  must  be  conducted  on  gen- 
eral principles.  The  isolation  of  the  patient  in  a  cool, 
well-ventilated  room,  and  the  dusting  of  the  affected  sur- 
face with  finely  powdered  asbestos,  flour,  starch-powder, 
or  white  bismuth,  together  with  the  administration  of  a 
purgative,  and  care  as  to  diet,  which,  in  proportion  as  the 
malady  is  severe,  should  be  fluid,  light,  and  easily  digesti- 
ble, are  all  the  measures  that  avail  aught  in  the  type  of 
disease  where  the  inflammatory  process  is  confined  to  the 
superficial  skin  layers.  In  the  phlegmonous  form  the  pa- 
tient must  be  placed  under  surgical  treatment,  for  early 
and  free  incisions  are  often  advisable  to  relieve  the  ex- 
treme tension  of  the  inflammatory  exudations  and  to  save 
the  deeper  tissues  from  destruction. 

Pyaemia  (called  also  Septic<£7nia). 

Under  the  term  of  pyaemia  is  probably  included  rather 
a  group  of  similar  diseases  than  a  single  malady. 

Caused  by  a  micro-organism. 

Characterized  by  two  stages  : 

First  stage — that  of  incubation — the  ordinary  duration 
of  which,  judging  from  puerperal  cases,  is  about  forty- 
eight  hours.  This  stage  is  marked  by  a  rapid  pulse,  by 
slight  fever,  and  general  malaise. 

tSecond  stage — that  of  advance — marked  by  shivering, 
nausea,  and  often  severe  vomiti^ig — ^the  intensity  of  the 
vomiting  being  often  a  gauge  of  the  malignancy  of  the 
poison — rapid  pulse,  a  sallov)  look,  dilated  inqnls,  a  rising 
temperature,  great  prostration  of  strength,  much  jK)er57J>^>«- 
tion^  a  peculiarly  svneet  odor  of  the  breath,  the  formation 


PYyEMIA    AND    TETANUS.  385 

frequently  of  abscesses  in  several  of  the  internal  organs. 
This  stage  may  last  for  days  or  weeks. 

Hesulting^  almost  surely,  in  death. 

Remarhs. — While  all  cases  of  pyaimia  present,  as  I  have 
said,  many  marks  of  a  family  likeness,  yet  the  fact  that 
typical  attacks  of  it  may  be  undoubtedly  caused  by  differ- 
ent poisons,  leads  to  the  conclusion  that  it  is  not  itself  a 
separate,  single,  and  specific  fever. 

Thus  the  contagion  of  scarlet  fever,  of  erysipelas,  of 
diphtheria,  of  typhus,  may  all  equally  produce  in  those 
whose  general  health  is  depressed,  and  whp  are  the  sub- 
jects of  recent  wound  or  abrasion,  pyaemic  symptoms,  and 
there  is  reason  to  think  that,  quite  independently  of  any 
of  them,  a  germ  capable  of  producing  pyaemia  may  de- 
velop in  any  unwholesome  animal  discharge  under  certain 
conditions  of  moisture  and  heat ;  thus  the  decomposing 
urine  often  passed  by  the  aged  or  by  those  who  are  the 
subjects  of  bladder  disease  will  produce,  if  introduced  into 
a  recent  wound,  this  disorder. 

Puerperal  Fever  (^.  e.,  child-bed  or  lying-in  fever)  is  sim- 
ply pyiemia,  and  is  a  disease  attended  by  a  frightful  mor- 
tality and  very  easy  of  transference.  Puerperal  peritonitis:^ 
an  inflammatory  state  consequent  sometimes  on  severe 
labor,  and  often  also  styled  puerperal  fever,  is  a  very 
different  and  far  less  fatal  disorder,  and  is  not  conta- 
gious. 

Treatment. — This  must  be  conducted  on  general  princi- 
ples. The  most  absolute  cleanliness  is  essential.  The 
general  strength  must,  as  far  as  possible,  be  maintained. 
No  drug  is  of  any  service. 

Tetanus. 

Caused  by  a  micro-organism. 
Characterized  by  two  stages  : 
17 


386  DISORDERS    OF   THE    BLOOD. 

First  stage— that  of  inciibatio?i— which,  is  rarely  longer 
than  three  days,  and  which  is  marked  by  no  noticeable 
symptoms. 

Second  stage — that  of  advance — sets  in  suddenly  with 
shivering  and  stiffness  of  the  neck^  extending  to  the  mus- 
cles of  the  jaw  and  tongue.  The  mouth,  by  the  stiffening 
of  the  muscles  of  the  jaw,  becomes  firmly  closed ;  hence 
the  popular  term  for  this  complaint  is  lock-jaw.  From  the 
face  the  stiffness  gradually  extends  to  the  other  muscles 
of  the  body,  and  is  aggravated  and  rendered  exceedingly 
painful  by  violent  spasms  which  contract  the  muscles  and 
contort  the  body.  Breathing  becomes  difficult  and  deglu- 
tition impossible  on  account  of  the  spasms  excited  by  ef- 
forts to  swallow.  There  is  moderate  fever,  a  rapid  pulse, 
and  great  perspiration. 

Beniarks. — Tetanus  closely  simulates  both  hydrophobia 
and  poisoning  from  strychnina.  It  may  follow  the  least 
scratch,  but  is  most  common  after  extensive  wounding 
with  a  dirty  instrument.  Exposure  to  cold  and  a  de- 
pressed condition  of  the  nervous  system  seem  to  predis- 
pose to  it.  Unlike  pya3mia,  it  is,  however,  exceedingly  rare 
after  confinement,  though  at  various  times  it  has  prevailed 
extensively  among  newly  born  infants,  in  whom  it  has 
been  called  "nine-day  fits,"  from  its  advent  in  the  second 
week  of  life.  In  these  cases  the  poison  enters  probably 
by  the  divided  umbilical  cord,  as  does,  not  unfrequently, 
that  of  erysipelas. 

Resulting  rarely  in  recovery. 

Treatment. — In  mild  cases,  which  are,  however,  rare 
and  often  doubtfully  tetanic,*  I  have  seen  apparently  ex- 
cellent results  from  the  administration  under  the  skin  of 
strychnina,  yV  of  a  grain  being  given  every  six  or  even 

*  Many  so-called  cases  of  tetanus  are  simply  instances  of  hjvsteri- 
cal  spasm. 


TETANUS    AND    HYDEOPHOBIA.  387 

every  four  hours  in  the  adult.  I  cannot,  however,  speak 
of  its  utility  in  severe  cases,  never  having  considered  my- 
self justified  in  making  in  such  cases  what  even  remotely 
might  be  considered  an  experiment.  For  such,  a  quick 
purge  and  the  keeping  of  the  patient  in  very  hot  but  dry 
air  are  the  first  measures,  and  by  Messrs.  Allen's  appara- 
tus, which  may  be  aftixed  to  any  bed,  a  temperature  of 
120°  to  150°  F.  can  be  easily  maintained  in  the  air  that 
surrounds  the  sufferer.  Then  conium,  belladonna,  chloral, 
hyoscyaraine,  nicotine,  or  Indian  hemp,  all  more  or  less 
muscle-paralyzers,  may  be  tried;  but  must,  if  given  at  all, 
be  administered  in  full  doses,  and  by  the  bowel  or  under 
the  skin. 

In  severe  cases,  chloroform  often  has  to  be  used  for 
prolonged  periods. 

In  hysterical  cases,  bromide  of  potassium  in  large  doses 
succeeds  in  speedily  producing  an  amelioration. 

Hydrophobia. 

Caused  by  a  micro-organism  capable  of  existing,  and 
probably,  under  some  conditions,  of  developing,  in  the 
blood  of  the  dog,  fox,  wolf,  cat,  and  other  animals.* 

Characterized  by  two  stages  : 

First  stage — that  of  incubation — which  may  exist  with- 
out noticeable  symptoms  for  weeks  or  months. 

Second  stage  —  that  of  invasion  and  advance  —  which 
commences  by  a  feeling  of  pain  in,  or  even  by  a  breaking 
open  again  of,  the  scar,  and  is  followed  by  a  sense  of  stiff- 
ness in  the  throat  and  neck,  some  feverishness,  and  a  very 
depressed  and  excitable  state  of  the  nervous  system.  This 
is  succeeded  by  a  period  of  great  and  almost  numiacal  ex- 
citement, during  which  spasms  of  the  muscles  of  the  body, 

*  Hydrophobia  is  really  an  eruptive  fever,  the  rash  of  which  ap- 
pears in  the  medulla  oblongata  and  spinal  cord. 


388  DISORDERS    OF   THE   BLOOD. 

but  especially  those  of  the  throat,  face,  and  chest,  are  fre- 
quent and  painful.  Sicalloicing  is  rendered  impossible  by 
the  frequency  of  the  spasms.  Constant  efforts  to  clear  the 
throat  and  frequent  spitting  are  common  symptoms. 

Resulting  in  death  in  two  or  three  days. 

Treatment, — To  be  efficacious,  the  treatment  must  be  car- 
ried out  during  the  stage  of  incubation,  but  since  but  5  j^er 
cent,  of  those  bitten  become  eventually  attacked,  it  is  very 
difficult  to  gauge  the  results,  if  any,  that  are  achieved  by 
the  different  systems.  Inoculation  by  Pasteur's  method 
seems  to  confer  an  immunity  from  the  disease  on  the  dog, 
and  probably  would  also  do  so  in  the  case  of  man  ;  but,  as 
there  are  certain  risks  attendant  on  the  process,  no  one  so 
far  has  ventured  to  submit  to  it  as  a  mere  preventative.  It 
is  exceedingly  questionable  if,  after  having  been  bitten  by 
an  animal  suffering  from  rabies,  inoculation  is  of  any  real 
service.  Experience  has  so  far  failed  to  confirm  the  hopes 
first  excited  by  this  means  of  treatment,  and  judging  by 
the  analogy  of  vaccination — which  is  powerless  to  prevent 
the  advent  of  small-pox  in  one  already  in  the  stage  of  in- 
cubation— this  system,  like  so  many  others,  is  probably 
doomed  to  fall  into  discredit. 

I  have  no  faith  whatever  in  the  ordinary  application  of 
nitrate  of  silver  to  the  recent  bite.  If  the  wound  be  on 
a  finger,  a  firm  ligature  must  at  once  be  applied  close  to 
its  junction  with  the  hand,  and  the  wound  must  be  vigor- 
ously sucked.  If  any  other  measures  are  taken,  nothing 
short  of  a  free  excision  of  the  wound,  and  the  encourage- 
ment of  the  bleeding  by  keeping  the  wound  in  warm  wa- 
ter containing  a  quantity  of  carbolic  acid  (two  or  three 
tablespoonfuls  to  the  quart  of  hot  water)  should  be  at- 
tempted. If  the  dog  be  undoubtedly  rabid,  and  the  liga- 
ture aj^plied  has  been  tight  enough  to  efficiently  arrest 
circulation,  it  is  best  to  amputate  the  finger,  or  at  least  by 


HYDROPHOBIA    AND    PURPUKA.  389 

leeches  or  incisions  to  endeavor  to  completely  drain  it  of 
blood. 

When  once  hydrophobia  has  become  thoroughly  devel- 
oped, it  is  questionable  if  any  drug  is  of  service.  The 
line  of  treatment  is  then  similar  to  that  in  tetanus. 

It  is  always  well  to  remember  that,  even  if  hydrophobic 
symptoms  supervene  on  the  bite  of  a  rabid  animal,  it  does 
not  follow,  necessarily,  that  real  hydrophobia  is  present, 
for  fear  may  determine  an  attack  of  an  hysterical,  pseudo- 
hydrophobic  nature,  which  may  even  be  accompanied  by 
some  recrudescence  in  the  wound.  I  have  seen  two  cases 
of  this  kind,  both  of  which  made  good  recoveries. 

To  this  short  list  of  fevers  "which  can  only  be  commu- 
nicated by  inoculation  through  a  broken  skin  surface, 
might  be  added  no  doubt  many  others,  such  as  the  "  ma- 
lignant pustule^''  from  which  butchers  sometimes  suffer ; 
2jost-mortem  blood-poisoning,  from  which  more  than  one 
promising  pathologist  has  died;  glanders  or  farcy,  a  dis- 
ease communicable  by  the  horse  to  man ;  and  many  others. 

Derangements  of  the  Blood,  probably  7ion-bacterial  in 

nature. 

Leaving  on  one  side  diseases  of  the  blood  from  inocula- 
tion of  the  venom  of  certain  reptiles,  a  subject  Avhich, 
fortunately,  in  England  is  scarcely  within  the  range  of 
practical  medicine,  and  also  those  due  to  the  existence  in 
the  blood-stream  of  mineral  and  vegetable  poisons,  and  to 
which  w^e  have  already  referred,  we  have  left  to  us  for 
discussion  under  the  above  heading  but  two  complaints, 
both  rare  at  the  present  day. 

Purpura. 

(a)  Purpura  Simplex. — This  is  not  a  very  formidable, 
though  it  is  a  somewhat  peculiar,  disorder.     It  consists  in 


390  DISORDERS    OF    THE    BLOOD. 

a  morbid  condition  of  the  blood,  sometimes  the  immediate 
consequence  of  rheumatic  fever  or  of  jaundice,  at  other 
times  originating  without  apparent  cause  and  quite  sud- 
denly. It  is  usually  not  marked  by  any  rise  of  tempera- 
ture (i.  e.,  is  non-febrile),  and  often  interferes  but  little 
with  the  sufferer's  comfort. 

It  is  characterized  by  the  sudden  appearance  on  the  shin 
of  purple  spots,  varying  in  size  from  a  pin's-head  to  a  large 
patch.     The  spots  do  not  disappear  on  pressure. 

These  spots  are  produced  by  hemorrhages  under  the 
skin,  and  are  akin  to  the  so-called  petechia?,  which  are 
seen  in  typhus  and  sometimes  in  small-pox,  and  are  always 
due,  in  whatever  disease  they  may  occur,  to  a  feebly  co- 
agulable  state  of  the  blood,  the  result  of  some  morbid 
process. 

{h)  Purpura  Hcamorrhagica. — This  is  a  much  more  se- 
vere form  of  purpura,  for,  in  addition  to  the  local  purple 
skin  spots,  free  bleeding  takes  place  from  the  mucous  mem- 
branes of  the  mouth,  nostrils,  bowel,  and  urinary  track, 
sometimes  into  the  pericardium  and  pleuroe,  and  not  un- 
frequently  into  the  brain. 

Like  simple  purpura,  it  may  arise  spontaneously,  or  may 
accompany  or  follow  some  other  disease,  especially  acute 
and  sub-acute  rheumatism,  typhoid  and  typhus  fever,  and 
severe  affections  of  the  liver. 

Scurvy  (Scorbutus). 

A  chronic,  non-febrile  disease,  consisting,  like  purpura, 
in  a  badly  coagulable  condition  of  the  blood,  and  marked 
therefore,  like  it,  by  extravasations  of  blood  under  the 
skin  and  sometimes  into  the  deeper  structures  of  the 
body. 

The  main  symptoms  are — the  appearance  on  the  body 
of  purple  spots  or  patches,  the  skin  over  which  sometimes 


PURPURA    AND    SCURVY. LEUCOCYTH^MIA.  391 

breaks  down,  particularly  on  the  legs,  producing  large, 
black  ulcerations.  Great  debility  and  pallor  of  the  skin, 
2^ai7is  in  the  back  and  limbs,  breathlessness  on  exertion, 
X>alpitation,  great  sponginess  and  swelling  of  gums,  which 
bleed  on  pressure,  and  foetor  of  the  breath  are  other  com- 
mon accompaniments. 

Caused  by  defects  in  diet,  especially  by  want  of  fresh 
vegetables. 

B,emarks  on  Purpura  and  Scurvy. — There  is  a  strong 
general  likeness  in  the  symptoms  of  both.  The  latter  is, 
however,  marked  by  much  greater  prostration,  and  is  easi- 
ly curable  by  means  of  good  diet,  with  plenty  of  fruit  and 
vegetables.  Lime-juice  is  a  well-known  preventative  and 
cure.  Scurvy  is  rare  among  sailors  at  the  present  day, 
but  may  sometimes  be  seen,  in  a  mild  form,  among  poor 
and  badly  fed  seamstresses.  Purpura,  though  by  prefer- 
ence it  selects  the  poor,  is  not  confined  to  the  under-fed; 
it  is  not  improved  by  lime-juice,  nor  even  markedly  im- 
proved by  a  good  diet.  It  disappears,  in  all  cases  that 
recover,  of  its  own  accord,  being  unaffected  by  any  known 
treatment,  rest  (the  most  absolute  rest  is  essential  in  bad 
cases)  and  quiet  being  the  only  agents  that  assist  recovery. 

It  is  exceedingly  probable  that  both  purpura  and  scurvy 
are,  like  the  diseases  which  we  are  now  about  to  study, 
mere  secondary  consequences  of  disorder  in  the  blood- 
glands. 

III.  DISORDERS  OF  THE  BLOOD-FORMING  GLANDS. 

Leucocythaemia. 
A  chronic  disease  of  the  spleen  or  of  the  lymphatic 
glands,  or  of  both. 

Characterized  by  enlargement  of  the  spleen  or  lymphatic 
glands  of  the  body,  or  of  both,  unaccompanied  by  any 
pain  or  fever;  by  a  great  increase  in  the  ichite-blood  cor- 


392         DISORDERS    OF   THE    BLOOD-FORMING   GLANDS. 

2ntsdes  and  a  corresponding  diminution  in  the  red,  and 
hence  by  extreme  pallor  and  debility^  vdth  a  tendency  to 
dropsy,  and  to  heynorrhayes  that  are  difficult  of  arrest. 

Caused  sometimes  by  repeated  attacks  of  ague,  some- 
times by  syphilis,  but  often  originating  spontaneously. 

Remarks. — In  addition  to  the  enlargement  of  the  spleen 
and  of  the  lymphatic  glands,  there  is  concomitantly  a  ten- 
dency to  increase  in  size  of  the  lymphatic  tissue  of  the 
body  generally.  Leucocythaemia  is  a  rare  disease,  and  is 
in  nearly  every  case  slowly  fatal. 

Treatmetit. — When  the  disease  commences  in,  and  is 
confined  solely  to,  the  spleen,  the  only  rational  treatment 
is  to  remove  that  organ.  No  drug  is  of  the  least  service. 
The  maintenance  of  the  general  health  by  means  of  change 
of  air,  good  food,  etc.,  is  the  object  to  be  aimed  at. 

Adenia  (or  Hodgkin's  Disease). 

A  chronic  disease  of  the  spleen  and  the  lymphatic 
glands,  resulting  in  their  enlargement  and  in  the  second- 
ary derangements  which  flow  from  an  impoverished  blood 
supply. 

Adenia  is  identical  in  every  respect  with  leucocythaemia 
except  in  this  particular,  that  in  Adenia  there  is,  with  the 
diminution  of  the  number  of  red-blood  corpuscles,  no  in- 
crease in  the  mimher  of  white  ones. 

Addison's  Disease. 

A  chronic  disease  marked  by  enlargement  and  often  by 
degeneration  of  the  supra -renal  capsules  (small  bodies 
supposed  to  play  the  part  of  blood-glands  and  situated 
upon  the  kidneys). 

Characterized  by  a  brown  discoloration  of  the  sJci?i, 
particularly  in  the  regions  of  the  grom,  armpits,  hands, 
and  face,  and    sometimes    also    of    the    lips,  gums,  and 


AX^MIA.  393 

tongue;  by  great  poverty  of  the  blood  {ancemia),  and  by 
debility. 

Caused  by  unknown  conditions. 

Resulting,  sooner  or  later,  in  death  from  exhaustion  or 
secondary  derangements. 

Treatment  consists  in  attempts  directed  to  the  mainte- 
nance or  improvement  of  the  general  health. 

Progressive  Pernicious  Anaemia. 

A  chronic  and  rare  disease,  due  probably  (since  the 
spleen  is  often  found  enlarged  and  softened)  to  some  ob- 
scure failure  of  the  blood-forming  organs. 

Characterized  by  all  the  symptoms  of  greatly  impover- 
ished blood — e.  g.,  pallor^  breathlessness,  debility^  vertigo, 
headache,  palpitation,  sleeplessness,  vomiting,  and  copious 
hemorrhages  into  the  skin  or  internal  organs.  Often 
marked  also  by  fever. 

Caused  by  unknown  conditions. 

JResulting  almost  invariably  in  death. 

Treatment  to  be  directed  to  the  maintenance  of  as  high 
a  state  of  health  as  possible. 

Hemarks. — The  causation  of  this  extraordinary  disease 
is  still  a  matter  of  dispute;  one  author  {e.g.^  Dr.  William 
Hunter)  attributes  it  to  the  entrance  of  some  poison  into 
the  blood-current,  and  this  view  is  not  an  improbable  one. 

Simple  Anaemia. 

A  poverty  of  blood  consisting  in  diminution  in  all  the 
constituents  of  the  blood.  Though  often  spoken  of  as  a 
separate  disease,  it  is  merely  a  symptom  which  may  be 
attendant  on  any  one  of  the  following  disorders: 

[  Deficient  food. 
a.  I  Inability  to  swallow  or  digest  food. 

'  "  absoi'b  food. 

17* 


394         DISORDERS    OF    THE    BLOOD-FORMIXG    GLANDS. 

Derangement  of  blood-forming  glands. 
"  circulation. 

*  I  "  lungs   {i.  €.,  of  aeration  of  the 
(^  blood). 

Loss  of  blood : 

(a)  from  bowel,  as  in  piles. 

(b)  from  womb,  etc.,  as  in  profuse  hemor- 

*  '  rliages  accompanying  female  derange- 
ments. 

(c)  from  kidney  (as  in  Briglit's  disease). 
J    \  Profuse  discharges  from  sores. 

(  Cancerous  and  other  internal  diseases. 

The  treatment  consists: 

(a)  In  the  removal  of  the  cause. 

(h)  In  the  maintenance  and  improvement  of  the  gen- 
eral health.  In  those  under  forty  years  of  age  an  in- 
crease in  the  number  of  red-blood  corpuscles  may  be  ac- 
celerated by  the  administration  of  ferruginous  tonics 
(Formulae  Nos.  16,  17,  18). 

Sufferers  from  anaemia  are  more  often  plump  than  thin, 
the  deficiency  of  red-blood  corpuscles  leading  to  the  de- 
posit, as  fat,  of  much  of  the  fuel-food  consumed. 

Chlorosis. 

A  condition  of  anaemia  common  in  young  unmarried  fe- 
males between  thirteen  and  twenty-five  years  of  age,  and 
marked  by  certain  special  characters. 

The  condition  of  the  blood  in  chlorosis  differs  from  that 
in  other  forms  of  anaemia,  inasmuch  as,  with  small,  badly 
formed,  and  deficient  red-blood  corpuscles,  the  other  con- 
stituents of  the  blood  are  normal  in  amount  and  kind. 

To  the  ordinary  symptoms  of  anaemia — i.  e.,  pallor, 
breathlessness,  di/s^yepsia,  debility,  etc. — there   are  gener- 


CHLOROSIS    AND    EXOPHTHALMIC    GOITRE.  395 

ally  superadded  marked  constipation,  hysterical  symp- 
toms, and  Avhite  discharges,  while  the  periods  are  either 
entirely  absent  or  are  scanty  and  pale.  The  sufferers  are 
w'm.'dSS.j  phmip. 

Caused  by  unknown  conditions,  but  certainly  connected 
with  functional  torpor  of  the  organs  of  reproduction, 
hence  the  old  term  for  this  disease,  Pallor  Virginura. 

The  advent  of  the  disease  is  favored  by  bad  hygienic 
conditions. 

Resulting  nearly  always  in  recovery. 

Remarks. — Though  often  a  cause  of  great  alarm  to  anx- 
ious mothers,  chlorosis  is  singularly  amenable  to  cure  by  all 
the  means  which  tend  to  improvement  of  the  general  health. 

Treatment  consists  in  improving  the  health  by  fresh 
air,  rest,  and  good  food.  Medicines  that  contain  iron 
often  do  good  (Aj)pendix,  Formulae  Nos.  16,  17,  18).  Mar- 
riage cures  the  disorder. 

Exophthalmic  Goitre  (Graves's  Disease). 

A  disease  rare  in  males,  and  most  common  in  unmar- 
ried females  between  the  ages  of  thirteen  and  twenty-five 
years. 

Marked  by  all  the  symptoms  of  a^icemia,  plus  an  en- 
largement of  the  thyroid  gland  in  the  throat,  (^.  e.,  goitre), 
a  protrusion  of  the  eyeballs,  constant  palpitation,  and 
great  nernous  excitability. 

Caused  probably  by  derangement  of  some  portion  of 
the  sympathetic  nervous  system  situate  in  the  neck;  some- 
times of  a  functional  nature  and  dependent  on  temporary 
disorder  of  the  reproductive  system,  and  then  curable  ; 
sometimes  of  an  organic  nature  and  incurable. 

Resulting  sometimes  in  death,  sometimes  in  recovery. 

Treatment. — The  cautious  application  of  the  constant 
electric  current  over  the  affected  part  of  the  sympathetic 


396         DISORDERS    OF    THE    BLOOD-FORMING    GLANDS. 

nervous  system  often  does  good  in  cases  where  functional 
derangement  alone  is  present.  Efforts  to  improve  the 
general  health  must  be  made. 

Remarks. — In  exophthalmic  goitre  the  prognosis  de- 
pends entirely  upon  the  age  and  general  surroundings. 
If  the  patient  be  female,  young,  unmarried,  and  chlorotic, 
the  outlook  is  generally  favorable;  in  all  other  cases  it  is 
grave. 

The  strong  family  likeness  between  the  different  dis- 
eases of  the  blood-glands,  almost  approaching  to  identity 
in  leucocythfemia  and  adenia,  and  again  in  anaemia  and 
chlorosis,  admit,  though  the  exact  pathology  of  none  of 
them  is  accurately  determined,  of  one  or  two  useful  gen- 
eralizations. 

We  have  on  the  one  hand  chlorosis,  simple  anaemia 
(here  spoken  of,  in  the  popular  way,  as  a  disease),  and  the 
form  of  exophthalmic  goitre  seen  in  young,  badly  fed,  and 
pale  girls,  all  often  due  to  a  mere  functional  derangement 
of  the  blood-forming  glands,  since  they  often  get  well, 
leavinof  no  trace  of  weakness  behind  them.  These  dis- 
orders  are  furthermore  often  consequent  on  weakening 
causes,  often  of  a  transient  nature,  for  the  period  of  life 
at  which  chlorosis  and  exophthalmic  goitre  appear  is  one 
in  which  great  demands  upon  the  body  are  made  by  the 
evolution  of  the  reproductive  organs,  and  the  reproduc- 
tive system  holds  in  females  a  much  more  prominent 
place,  in  relation  to  the  whole  body,  than  it  does  in  men. 
Sufferers,  moreover,  from  the  diseases  named  are  not  as  a 
rule  only  passing  thus  through  a  critical  period,  but  they 
are  nearly  always  found  to  be  overworked,  underfed,  and 
living  in  bad  hygienic  surroundings.  It  is,  therefore,  not 
difficult  to  believe  that  in  a  temporary  failure  of  blood- 
making  organs  alone  may  often  lie  the  causes  of  all  these 
maladies.     Antemia,  again,  of  the  simple  order,  never  oc- 


RELATIOX    OF    TUESE    DISORDERS.  397 

curs  but  as  the  consequence  of  some  drain  on  the  system, 
and  disappears  when  this  is  arrested. 

On  the  other  hand  we  have  in  leucocythaemia,  adenia, 
and  Addison's  disease,  instances  of  an  inflammatory 
growth,  more  or  less  extended  and  affecting  the  blood- 
glands,  and  sooner  or  later  necessarily  followed  by  their 
degeneration  and  failure;  often  behind  this  again  being 
scrofula,  syphilis,  malarial  fever,  or  some  strong  heredi- 
tary predisposition- 


CHAPTEE  XIII. 

DISEASES  DUE  TO  DEFECTS  IN  THE  ORGANS  OF  THE 

FOOD    SYSTEM. 

DISOKDERS   OF    THE   LYMPHATICS. 

Arrangement  and  Functions  of  the  Lymphatic  Organs. 

Functional  Disorders  of     ^  Acute  and  Chronic  Rheumatism,  Syph- 
the  Lymphatics.  I     ills,  and,  to  some  extent,  Gout. 

r  Scrofula,   Inherited   Syphilis,   the   se- 

^'Tymplmtls' ""      ]      ^"'"'^  »'  Syphilis,  LeucocytUsEmia, 

I      Adenia,  Addison's  Disease. 


Ube  ifOOD   ^^5tCm—{conti7iued). 


CHAPTER    XIII. 

DISEASES  DUE  TO  DEFECTS  IN  THE  ORGANS  OF  THE 

FOOD  SYSTEM. 

IV.  DISORDERS  OF  THE  LYMPHATICS. 

The  lymphatic  system — for  so  tlie  lymphatics  are  called 
collectively  —  comprises  a  series  of  intercellular  spaces, 
ducts,  glands,  and  pumps. 

The  intercellular  spaces  are  the  irregular  cavities  which 
surround  the  cells  of  the  body,  and  into  which  the  serum 
of  the  blood,  as  it  exudes  from  the  capillaries  to  supply 
the  cells,  is  poured.  But  the  cells  cast  out  certain  waste — 
by-products  of  the  chemical  interchange  which  they  are 
constantly  undergoing — which  also  falls  into  the  inter- 
cellular spaces.  It  is  evident  therefore  that,  to  prevent 
surcharge  and  clogging  of  these  spaces,  they  must  from 
time  to  time  be  relieved  both  of  this  waste  and  of  any  ex- 
cess of  serum  albumen  which  they  may  contain.  This  is 
effected  by  means  of  the  movement  of  the  organ,  usually 
a  muscle,  in  which  the  spaces  are  situate,  and  which  acts 
the  part  of  a  pump,  compressing  these  spaces  from  time  to 
time,  and  forcing  their  contents  onward  into  the  lym- 
phatic ducts  which  take  their  origin  in  the  intercellular 
spaces.     Once  in  the  ducts,  backward  flow  is  prevented  by 


402  DISORDERS    OF    THE    LYMPHATICS. 

means  of  valves,  and  the  onward  current  is  promoted  by 
the  same  means  as  those  which  effected  the  emptying  of 
the  intercellular  spaces. 

The  lymphatic  ducts  pass  through  lymphatic  glands, 
where  the  lymph  undergoes  slight  changes,  and  where  any 
poisons  in  it  are  arrested,  onward  towards  its  final  destiny, 
the  internal  jugular  vein  at  the  root  of  the  neck.  But 
before  the  lymph  reaches  that  point  it  is  poured  into  cer- 
tain intervening  cavities  which  play  the  part  of  pumps. 
These  are  the  synovial  membranes  of  joints  w^hich,  thanks 
to  the  movements  of  the  limbs,  are  enabled  to  play  this 
role ;  the  pleurm  which  surround  the  lungs,  converted  to 
pumps  by  the  movements  of  the  lungs  ;  the  ^pericardium 
which  envelopes  the  heart,  and  which  utilizes  in  a  similar 
direction  the  force  transmitted  to  it  by  the  cardiac  move- 
ments ;  the  peritoneum  working  as  a  pump,  thanks  to  both 
the  respiratory  and  the  intestinal  movements. 

Such  are  the  great  cavities — for  they  are  really  closed 
sacs — into  which  the  lymph  is  poured,  and  such  the  source 
of  their  power  as  lympli  lyumps. 

To  these,  though,  not  closed  cavities,  must  be  added  the 
serous  surfaces  of  the  body,  especially  the  serous  mem- 
branes tohich  line  the  heart  and  its  valves,  the  arteries  and 
the  veins,  which,  themselves  a  direct  continuation  of  the 
lymphatic  ducts,  aid,  probably  by  the  force  derived  from 
the  movements  of  the  organs  which  they  line,  in  the  lymph 
circulation. 

Emptied  thus  into  the  large  closed  sacs  I  have  men- 
tioned— which  with  their  contained  lymph  form  a  species 
of  protective  water-cushion  for  the  important  organs  that 
they  envelope,  while  at  the  same  time  acting  as  pumps — 
the  lymph  remains  therein  for  a  time,  to  be  eventually 
pumped  along  larger  lymph  channels  into  the  base  of  the 
internal  jugular  vein  at  the  root  of  the  neck.    Once  again 


THE    LYMPHATIC    SYSTEM.  403 

in  the  blood  circulation,  the  surplus  serum  in  the  lymph  is 
once  more  sent  round  by  way  of  the  heart  to  feed  the 
cells,  while  the  cell  debris  is  transported  to  the  kidneys 
and  skin  for  ejection  from  the  body. 

We  have  already  more  than  once  in  the  earlier  parts  of 
this  work  remarked  that  in  the  human  body — the  result, 
so  the  evolutionists  say,  of  the  continual  struggle  for  ex- 
istence and  the  constant  natural  increase  of  perfection  in 
the  survivors  from  the  struggle — an  economy  of  function 
is  practised  wherever  this  is  possible.  Indeed,  in  the  great 
lymph  sacs  we  have  had  an  instance  of  organs  playing  a 
dual  part,  so  is  it  in  the  lymphatic  system  of  ducts  and 
glands  which  has,  so  to  speak,  tacked  on  to  it  a  pseudo- 
lymphatic  department  situate  in  the  abdomen  and  con- 
cerned in  the  absorption  of  emulsionized  fat  in  the  intes- 
tine. The  open  ends  of  the  ducts  appertaining  to  this 
division  take  up  the  particles  of  fat,  transmit  them  through 
the  lymphatic  (called  also  lacteal)  glands  of  the  abdomen, 
and  empty  them  eventually,  mingled  with  the  cell  debris 
and  the  surplus  serum,  of  which  I  have  already  spoken, 
into  the  internal  jugular  vein. 

The  lymphatic  ducts,  therefore,  in  their  ultimate  and 
largest  channels  (those  that  lead  direct  into  the  vein)  con- 
tain cell  debris,  serum,  and  emulsionized  fat,  the  latter  des- 
tined, as  we  know,  for  a  fuel-food. 

The  lymphatic  glands  have  one  further  function,  for 
they  are,  in  what  manner  we  know  not,  manufacturers  of 
white-blood  corpuscles. 

Keeping  in  mind,  then,  the  anatomy  and  functions  of  the 
lymphatic  system,  we  shall  be  easily  able  to  comprehend 
the  otherwise  very  puzzling  and  inexplicable  sequence  of 
events  in  the  diseases  that  affect  this  system. 

These  are  of  two  kinds  :  t\\Q  functional,  due  to  a  tem- 
porary breakdown  of  the  lymphatic  system,  or  of  some 


404  DISORDERS    OF    THE    LYMPHATICS. 

portion  of  it  ;   and  the  degenerative^  due  to  some  organic 
change  leading  to  permanent  incapacity. 

{a)  The  chief  functional  disorders  of  the  lymphatic  sys- 
tem are  Acute  Rheumatism  (rheumatic  fevei-),  Chronic 
Rheumatism,  and  the  fever  Syphilis. 

Rheumatic  Fever,  or  Acute  Hhewnatism. — We  have  al- 
ready traced  in  disorders  of  nutrition,  combined  often 
with  failure,  from  overwork,  of  the  nervous  system  and 
check  of  the  functions  of  the  skin,  the  genesis  in  the  tis- 
sues of  the  poison,  uric  acid,  which  produces  this  febrile 
disease.* 

Now  just  imagme,  in  place  of  surplus  serum  and  cell 
debris  contained  in  the  intercellular  spaces,  the  surplus 
serum  in  contact  with  an  abundance  of  uric  acid  (and 
other  chemical  compounds  allied  thereto),  and  this  occur- 
ring either  in  a  broken-down  man  or  in  one  who  feeds 
to  excess  and  does  not,  by  neglecting  exercise,  bring  his 
lymph  pumps  into  proper  play,  and  we  shall  get,  as  a  nat- 
ural result,  pain  and  stiffness  in  one  or  more  muscles,  and, 
if  the  poison  travel,  as  it  often  does,  in  one  or  more  joints  ; 
in  short,  we  shall  have  Rheumatism  of  the  chronic  form, 
so  often  to  be  observed  in  the  aged,  and  which  is  incurable, 
because  the  body  is  rapidly  going  down  hill.  The  sufferer, 
by  clothing  in  flannel,  and  thereby  keeping  his  skin  in 
functional  activity,  by  careful  dieting  and  by  the  aid  of 
frictions,  and  perhaps  by  the  judicious  use  of  stimulants, 
will  manage,  with  more  or  less  success,  to  keejj  his  enemy 
back  ;  but  an  excess  of  moisture  in  the  air,  a  rapid  fall  in 
the  thermometer,  a  slight  want  oi  accustomed  exercise,  a 
little  extra  worry,  and  the  painful  disorder  will  quickly 

*  Some  maintain  that  a  special  micro-organism  is  the  cause  of 
rheumatic  fever  ;  but  even  if  this  he  so,  and  there  is  no  proof 
thereof,  the  poison,  uric  acid,  to  which  it  gives  rise  is  still  the 
materies  morhi  of  the  disorder. 


ACUTE    AND    CHRONIC    RHEUMATISM.  405 

reappear,  though  it  will  probably  not  get  beyond  one  or 
two  joints. 

In  a  younger  man  the  course  is  different.  His  body  is 
vigorous  and  tolerant,  and  in  the  disease  we  are  now  con- 
sidering, as  in  gout  and  biliousness,  the  poison  will  go  on 
accumulating,  producing  merely  an  occasional  twinge  and 
a  little  malaise,  till,  all  at  once,  a  revolution  in  the  long- 
suffering  body  breaks  out  as  a  result  of  some  extensive 
arrest  of  the  functions  of  the  skin,  as  by  sleeping  in  damp 
sheets,  etc.  The  damp  sheets  are  not  the  cause  of  the  dis- 
ease ;  they  represent  the  last  straw  that  brings  the  camel 
to  the  ground.  The  breach  between  the  poison  and  the 
body  must  have  come  in  any  case  unless  the  course  in  life 
had  been  radically  altered ;  the  damp  sheets  have  only 
precipitated  the  crisis.  And  now,  by  a  vigorous  course  of 
action,  the  body  proceeds  to  clear  off  the  poison,  to  square 
the  accounts. 

The  poison  advances  to  the  glands  and  joints,  and  these 
inflame ;  then  on  to  pleurae,  producing  pleurisy;  to  the  peri- 
cardium, producing  pericarditis ;  to  the  serous  lining  of 
the  heart  and  blood-vessels,  producing  heart  disease  and 
often  arterial  mischief.* 

Such,  as  all  medical  men  and  many  laymen  know,  is  the 
course  of  Rheumatic  Fever  or  Acute  Rheumatism. 

The  peritoneum  and  the  under  surface  of  the  diaphragm 
are  not  generally  attacked,  for  they  belong  to  that  almost 
distinct  department  of  the  lymphatic  system  concerned  in 
the  absorption  of  the  fats,  and  therefore  have  not  much, 
either  in  function  or  in  disorder,  in  common  with  the  rest 
of  this  system. 

*  I  Lave  purposely  omitted  mention  in  this  connection  of  the 
serous  membranes  of  the  brain,  as  they  differ  somewhat  in  structure 
and  function  from  the  others,  and  are  but  comparatively  seldom  the 
seat  of  attack  in  rheumatic  fever. 


406  DISOKDERS    OF    THE    LYMPHATICS. 

What  are  the  terminations  and  lohat  is  the  treatment 
respectively  of  the  chronic  atid  acute  varieties  of  rheuma- 
tism described  ? 

The  end  of  chronic  rheumatism  is,  if  the  patient  be  aged 
or  incurably  feeble,  chronic  valetudinarianism,  but  the 
sufferings  may  be  relieved  by  exercise,  and  the  man  who 
suffers  from  rheumatism  well  knows  how  the  stiff  and 
painful  joints  in  the  morning  become  easy  and  supple 
after  a  little  use.  This  exercise  may  be  of  the  ordinary 
normal  kind,  or  may  be,  by  means  of  frictions  and  rub- 
bings, artificially  performed.  Any  measures  that  improve 
the  general  health,  as  well  as  all  those  which  maintain  or 
increase  the  skin  functions,  have  also  a  good  effect ;  a 
nourishing  but  simple  diet,  change  of  scene  and  of  occu- 
pation can  effect  the  former  indication,  the  wearing  of 
rough  flannels,  hot  baths  of  plain  water,  brine,  mud,  or 
sea-weed,  the  latter  purpose. 

Among  drugs,  iodide  of  potassium,  a  potent  and  special 
lymphatic  stimulant,  will  often  temporarily  effect  won- 
ders, but  it  should  be  always  combined  with  Peruvian  bark 
or  ammonia  to  check  in  some  sort  its  evil  effects  on  the 
body  at  large.  Guiaiacum,  guarana,  sulphur,  phosphorus, 
quinine,  and  a  host  of  other  drugs,  as  well  as  the  employ- 
ment of  some  forms  of  electricity,  are  often  of  tempo- 
rary avail,  but  they  are  all  local  stimulants,  and  the  ac- 
commodation they  afford  has,  subsequently,  to  be  paid 
for. 

The  termination  of  rheumatic  fever  or  acute  rheumatism 
is,  if  some  important  organ  attacked  does  not  succumb  to 
the  violence,  in  health,  for  the  feverish  process  is  a  purely 
curative  measure,  oxidizing  the  uric  acid  to  urea  and  cut- 
ting off,  by  the  removal  of  appetite,  the  supplies  of  fresh 
poison.  Often,  however,  as  we  know,  are  irremovable 
traces  of  the  ravacjes  wrousrht  left  behind  in  the  valves 


TREATMENT    OF   KHEUMATIC    FEVER.  407 

or  ojienings  of  the  heart  —  which  in  consequence  become 
unequal  to  their  work — or  in  the  pericardium  or  pleurae. 

The  treatment  of  rheumatic  fever  consists — 

{a)  In  rest  in  bed,  in  a  well- warmed  room,  the  patient 
lying  between  the  blankets  to  keep  the  skin  in  equable 
action. 

(&)  In  a  very  restricted  dietary. 

(c)  In  the  administration  of  certain  drugs. 

As  for  medicines,  the  medical  world  has  always  been 
divided  in  its  opinion  as  to  the  proper  course.  Speaking 
generally,  there  are  four  plans  : 

(1)  Endeavor  to  keep  the  kidneys  in  action  by  alkaline 
salts,  acetate  of  potash,  etc.  Keep  the  bowels  regular  by 
aperients.     Keep  the  skin  in  action. 

(2)  Apply  blisters  over  or  near  the  swollen  joints. 

(3)  Administer  iodide  of  potassium  in  large  and  repeated 
doses. 

(4)  Give  salicylic  acid  and  its  salts. 

It  is  impossible  in  the  limits  of  this  work  to  discuss  the 
relative  merits  of  each  system.  The  relief  given  by  full 
doses  of  the  salicylates  is  rapid  and  great,  but  the  draw- 
backs attendant  on  this  system  of  treatment  are  serious, 
and  the  real  utility  of  this  plan  is  open  to  grave  doubt. 
On  the  whole,  it  may  be  said  that  the  less  of  active  medi- 
cation be  undertaken  in  rheumatic  fever  the  better  for  the 
patient.  It  is  always  astonishing  to  those  who  had  never 
witnessed  it  —  and  there  are  many  who  are  quite  unac- 
quainted with  the  normal  history  of  unmeddled-with  dis- 
ease— to  see  how  splendidly  successful  a  do-nothing  sys- 
tem of  treatment,  as  far  as  drugs  go,  usually  is. 

My  own  practice  is  to  give  small  doses  of  the  citrate  of 
potassium,  or  of  the  acetate  of  potassium,  in  plenty  of 
water,  every  four  or  six  hours,  and  a  quarter  to  half  a 
grain  of  morphia  under  the  skin  at  bedtime  each  evening 


408  DISORDERS    OF    THE    LYMPHATICS. 

during  the  stress  of  the  attack,  and  but  rarely,  and  only  in 
exceptional  circumstances,  the  salicylates,  salol,  or  salicin. 

Gout  may  expend  some  of  its  fury  on  the  lymj^hatic  sys- 
tem, and  is  therefore  one,  but  as  compared  with  acute 
rlieumatism  an  uncommon,  cause  of  heart  and  arterial  dis- 
ease, or  even  of  chronic  disorder  of  the  pericardium  or 
pleurae. 

The  poison  of  rheumatism — -uric  acid  —  is  the  same  as 
that  of  gout,  but  its  place  of  production  is  the  liver,  not 
the  lymphatic  system. 

Syphilis  is,  as  we  know,  a  fever,  but  one  in  which  the 
brunt  of  the  attack  falls  from  the  first  on  the  lymphatic 
system.  One  of  its  earliest  symptoms  is  therefore  an  en- 
largement, all  over  the  body,  of  the  lymphatic  glands.  It 
pervades,  with  the  lymphatic  ducts,  every  part  of  the 
body,  and  its  consequences  and  ravages  may  take  place  in 
any  organ.  It  is  hardly  too  much  to  say  that  it  can  alone 
produce  almost  every  variety  of  disease,  except  the  fevers 
This  is  what  we  should  expect  from  such  a  general  dis- 
order of  the  ubiquitous  lymph  channels. 

The  treatment  has  already  been  discussed. 

(b)  Degenerative  changes  of  the  lymphatic  system,  w^hich 
give  rise  to  what  are  called  organic,  as  distinguished 
from  functional,  disorders,  are  at  the  root  of  some  of  the 
most  troublesome  —  and  necessarily  most  general  —  of 
diseases. 

Their  results  may  be  thus  enumerated  : 

(1)  Scrofula  and  tuberculosis. 

(2)  Inherited  syphilis. 

The  above  are  examples  of  congenital  degenerations,  so 
to  speak  ;  the  infant  affected  by  them  starting  life  with  a 
fatally  weak  lymphatic  system. 

(3)  The  sequelae  of  syphilis,  aggravated  by  mercurial 
poisoning. 


THE    DEGENEKATIVE    LYMPHATIC    DISORDEKS.  409 

(4)  Leucocythsemia. 

(5)  Adenia. 

(6)  Addison's  disease  (?), 

All  of  which  commence  during  the  life  of  the  suiferer  as 
inflammatory  processes,  and  end,  as  all  chronic  inflamma- 
tion must,  in  degenerative  changes. 

There  are  many  pathologists  who  hold,  and  with  very 
strong  reason,  that  syphilis  alone  is  at  the  bottom  of  all 
the  degenerative  failures  of  the  lymphatic  system.  Many 
times,  no  doubt,  the  syphilitic  taint  is  untraceable,  having 
originated  several  generations  before  the  sufferer  from 
scrofula  was  born,  and  has  only  been  brought  into  the 
witness-box  of  life  by  intermarriage  with  a  family  simi- 
larly heirloomed,  or  by  the  too-early  ages  of  the  parents, 
or  the  too-advanced  age  of  the  father,  or  by  a  fall  in  for- 
tune of  the  family;  the  strain  of  the  body  induced  by  want, 
worry,  and  the  hard  struggle  for  existence,  or  other  debili- 
tating cause,  bringing  out,  perhaps  late  in  life,  the  weak 
point  that  might  otherwise  have  remained  latent  and  un- 
suspected. There  are  many  stages  of  degeneration  in 
every  system  of  the  body,  each  with  its  special  train  of 
symptoms,  some  of  which  cannot  be  developed  in  a  single 
generation.  We  have  a  familiar  example  of  this  truth  in 
gout.  The  savage  cannot  be  made  gouty,  though  he  eat 
and  drink  everything  provocative  of  the  disorder  ;  it  takes 
more  than  one  generation  of  gluttony  to  evolve  the  full- 
blown disease  which  passes  by  the  name  of  gout,  while  it 
is  only  in  recent  times  that  a  great  variety  of  symptoms, 
formerly  classified  as  distinct  disorders,  have  been  proved 
to  be  but  varying  manifestations  of  the  same  disorder. 

Just  as  chemistry  has  gradually  reduced  the  list  of  sim- 
ple elements,  and  is  still  further  reducing  their  number, 
showing  that  what  formerly  were  classified  as  such  are, 
after  all,  but  compounds  of  other  elements,  so  in  medicine 
18 


410  DISORDEKS    OF   THE    LYMPHATICS. 

a  simplification,  which  will  yet  make  great  advances,  marks 
our  steadily  accumulating  stock  of  knowledge  ;  and  the 
time  is  probably  not  far  distant  when,  to  failures  and  mis- 
takes in  nutrition  on  the  one  hand,  and  to  poisons,  such  as 
that  of  syphilis  and  of  the  other  fevers,  or  that  of  mineral 
or  vegetable  origin,  on  the  other,  will  be  conclusively 
traced  every  derangement,  functional  and  organic,  of  the 
human  body. 

In  that  day  the  practice  of  medicine  will  have  become 
really  scientific,  and  will  be  able  to  command  the  confi- 
dence and  gratitude  of  all  humanity. 

In  the  meantime,  however,  we  must  discuss  degenera- 
tive disorders  of  the  lymphatic  system  as  separate  and 
distinct  entities. 

Scrofula  (or  Struma). — The  underlying  cause  of  all  the 
manifestations  of  scrofula  lies  in  an  inherited  debility  of 
the  whole  lymphatic  system. 

This  reacts,  of  course,  upon  the  general  bodily  health, 
and  thus,  independently  of  the  very  characteristic' phe- 
nomena dependent  on  this  lymphatic  failure,  and  which 
we  shall  presently  allude  to,  there  is,  from  the  time  of 
birth,  a  generally  unsatisfactory  state  of  health,  which,  in 
all  bad  cases,  stamps  the  individual  with  certain  marked 
features  which  make  a  diagnosis  very  quick  and  easy.  The 
following  are  some  of  the  common  characteristics  of  the 
scrofulous  type  of  individual,  as  seen  in  children  : 

The  color  of  the  hair  is,  in  the  majority  of  cases,  dark  ; 
the  abdomen  large  and  tumid ;  the  tonsils  swelled ;  the 
glands  of  the  neck  distinctly  to  be  felt  as  hard  lumjys  un- 
der the  skin  ;  the  scalp  and  other  parts  of  the  body  sur- 
face exhibit  a  tendency  to  eruptions ;  the  eyes  are  often 
v^eak^  and  small  ulcers  on  their  surfaces  are  not  uncommon; 
discharges  from  the  nose,  eyes,  and  ears  are  common, and 
difficult  to  cure  ;   the  stomach  and  bowels  are  often  de- 


TYPES    OF    SCROFULOUS    CHILDREN.  411 

ranged  and  the  appetite  ecqyricious,  in  some  cases  excessive; 
the  intellect  is  dull  and  the  habits  often  uncleanly  ;  the  cir- 
culation is  sluggish.  The  itpper  lip  is  often  thick  and 
short,  and  the  head  large.  Sometimes,  as  a  result  of  ex- 
cess of  water  on  the  brain,  the  forehead  projects.  The 
fingers  are  often  clubbed.  The  sufferer  may  appear plwnp^ 
but  this  is  not  the  result  of  muscular  develo^^ment  and 
healthy  fat,  but  rather  of  a  serous  infiltration  of  the  tis- 
sues. In  these  children  the  fevers,  especially  measles  and 
scarlet  fever,  tend  to  assume  a  serious  aspect,  the  throat 
and  glands  of  the  neck  becoming  badly  aU'ected,  and  ob- 
stinate discharges  of  matter  from  the  ear  tending  to  be  set 
up.  This  class  of  child  is  always  improved  by  fats,  though 
such  food  is  instinctively  shunned,  being  of  course  badly 
assimilated,  and  therefore  an  easily  digested  fat,  such  as 
cod- liver  oil,  will  often  do  great  good.  Sea  air,  both  by 
whipping  up  the  circulation  and  relaxed  system,  and  by  the 
iodine  which  it  contains,  always  effects  an  improvement. 

There  is,  however,  sometimes,  but  rarely,  to  be  seen  a 
scrofulous  type  of  very  different  mould.  In  children  of 
this  class  the  face  is  oval,  the  eyes  bright,  t\\ep)iqnls  large, 
the  features  regular.  The  body  is  thin,  the  limbs  straight 
and  shapely,  the  head  rather  small,  and  the  intellect  clear 
and  markedly  precocious.  This  angel-type  of  child  is  the 
delight  of  its  teachers,  being  sharp  and  quick  and  good. 
Of  such  children  the  nurses  of  old  "were  vv^ont  to  say  that 
they  were  "  too  good  to  live." 

Having,  then,  in  deference  to  the  special  importance  of 
this  disease,  gone  out  of  our  way  to  make  a  picture  of  in- 
dividual sufferers  which  can,  however,  never  convey  any 
real  instruction  unless  the  dependence  of  each  symptom 
and  special  trait  on  the  underlying  cause  be  also  under- 
stood, let  us  return  to  a  close  study  of  scrofula  in  its  evo- 
lution from  a  mere  debility  of  the  lymphatic  system  at 


412  DISOKDERS    OF   THE    LYMPHATICS. 

birth,  to  a  vast  and  varied  series  of  phenomena  in  youth 
and  middle  as^e. 

Now,  the  lymphatic  system  is  concerned  in  the  absorp- 
tion of  fats,  and,  in  common  with  the  kidneys,  skin,  and 
lungs,  in  the  removal  of  waste. 

One  of  the  earliest  symptoms  of  scrofula  is  a  repug- 
nance— instinctive  in  character— /or /"a^s,  with  which  falls 
also  to  be  noted  the  instructive  fact  that,  in  whatever 
form  of  bodily  derangement  scrofula  may  appear,  the  ad- 
ministration of  fats  easy  of  assimilation  will  always  effect 
an  improvement  therein  or  even  a  temporary  cure. 

Again,  if  one  set  of  the  excretory  organs,  such  as  the 
lymphatic  ducts  and  glands,  fail,  the  extra  work  thrown 
upon  the  others,  that  are  similar  in  function,  will  lead  to 
their  frequent  derangement:  this  is  only  what  we  should 
expect,  and,  as  a  matter  of  common  experience,  nearly 
every  form  of  shin  disease  and  nearly  every  variety  of  kid- 
ney disease  (except  gouty  kidney),  7nost  of  the  grave  dis- 
orders of  the  liD^g,  and  many  of  the  milder  ones,  have  in 
scrofula  their  undoubted  orio'iD. 

In  the  lymphatic  system  itself  the  disorder  is,  of  course, 
evidenced.  The  tonsils,  which  are  mainly  in  their  struct- 
ure and  function  lymphatic  glands,  become  enlarged,  while 
the  glands  of  the  neck  may  readily  be  felt  by  the  fingers, 
and  sometimes  undergo  an  exceedingly  slow  variety  of  in- 
flammation, unattended  by  marked  pain  or  local  heat,  and 
spoken  of  in  popular  language  as  "  cold  abscesses.''''  These 
swellings  sometimes  break,  leaving  unseemly  scars  on  the 
neck,  always  rightly  regarded  as  strong  evidence  of  scrofu- 
lous taint.  This  glandular  swelling  is,  however,  not  con- 
fined to  the  region  of  the  neck,  but  is  general  all  over  the 
body,  the  glands  in  the  abdomen  being  sometimes  evident 
to  touch  as  deep-seated  hard  masses  of  the  size  and  shape 
of  filberts.     Many  of  the  obscure  derangements  of  scrofu- 


TUBERCULAR    CONSUMPTION.  413 

lous  children  are  due  to  swelling  of  the  deeper  glands,  and 
many  a  chronic  cough  is  kept  up  by  presence  of  such  en- 
larged glands  in  some  part  of  the  lungs. 

Bone  disease  commencing  in  the  fibrous  sheath  which 
coats  both  the  external  surfaces  and  the  inner  cavities  of 
bones,  and  which  is  rich  in  lymphatics,  is  one  of  the  com- 
monest of  scrofulous  ailments. 

Diseases  of  the  lymph  pumps  are,  of  course,  frequent 
sequences  of  scrofula,  the  synovial  and  serous  membranes 
of  joints  are  often  attacked,  the  disease  advancing  till  the 
bone  itself  becomes  affected  and  the  use  of  the  joint  ir- 
reparably lost ;  the  peritoneum,  the  pleurae,  the  pericar- 
dium, the  lining  serous  membranes  of  the  heart,  arteries, 
and  of  the  brain  itself  being  also  often  the  seats  of  scrofu- 
lous disorder. 

But  the  disease  par  excellence  of  scrofula  is  consumption. 

It  would  be  difficult  to  find  a  stronger  example  of  the 
evil  system  in  vogue  for  the  classification  of  maladies  than 
in  the  use  of  the  one  term  consimiptioii  or  phthisis  to 
cover  at  least  three  widely  different  states  of  the  body, 
each  demanding  different  treatment.  I  will  dwell  briefly 
upon  the  scrofulous  varieties  and  will  merely  mention  the 
others,  deferring  a  discussion  of  them  till  the  subject  of 
lung  derangements  shall  arise. 

Tubercular  Consumption. — This,  the  commonest  of  all  the 
varieties  of  this  malady,  is  purely  of  scrofulous  origin. 
Its  genesis  from  scrofula  is  as  follows.  An  inflamed 
scrofulous  gland  slowly  breaks  down  in  any  part  of  the 
body,  and  the  peculiar  whey-like  matter,  in  place  of  being 
evacuated  through  the  skin,  is  slowly  absorbed  by  the 
lymphatics  leading  from  the  gland,  and  thus  sets  up  mis- 
chief, sometimes  in  all,  sometimes  only  in  some,  of  the 
lymphatic  glands  and  ducts. 

If  the  whole  lymphatic  system  is  thus  poisoned  we  get 


414  DISORDERS    OF   THE    LYMPHATICS. 

the  frightful  disease,  general  tuberculosis,  wliich  runs  a 
course  of  from  one  to  six  Aveeks  and  alvmys  terminates 
fatally.  This  is  the  '"''galloping  consurnxMon''''  known  to 
the  ]^)ublic,  and  which  we  have  already  discussed.  More 
often,  however,  the  poisoning  of  the  lymphatic  system, 
though  extensive,  is  most  marked  in  one  region  only  of 
the  body.  In  children  this  region  is  the  abdomen,  and  we 
thus  get  "  abdominal  tubercular  phthisis,"  or  "  Consump- 
tion of  the  Bowels"  as  it  is  popularly  called.  This  is 
marked  by  painless  swelling  of  the  abdomen,  irregular  ac- 
tion of  the  bowels,  extreme  wasting  and  debility.  The  ap- 
petite may  be  absent  or  voracious. 

As  the  disease  advances,  the  enlarged  lymphatic  glands 
in  the  abdomen  may  easily  be  felt  by  the  hand.  Some- 
times from  the  first,  always  towards  the  end  of  the  mal- 
ady, the  tubercular  poison  spreads  to  the  lungs,  brain,  and 
body  at  large,  causing  everywhere  an  enlargement  of  the 
glands.  Recovery  is  possible  if  the  disease  be  at  first 
local  and  early  recognized.  It  is  always  fatal  when  ad- 
vanced. Its  treatment  is,  of  course,  that  of  scrofula  gen- 
erally— the  administration  of  foods,  especially  of  easily 
digested  fats,  sea  or  good  country  air,  and  the  adoption 
of  every  means  to  improve  the  general  health. 

In  the  adult  the  lungs  are  generally  the  seat  of  the  at- 
tack, and  here  again  the  disease  may  be  at  first  local  and 
perhaps  curable,  subsequently  extending  to  the  whole 
body,  or  may  from  the  very  first  be  general  in  character, 
but  most  prominently  miscliievous  in  the  lungs.  In  these 
organs,  as  in  the  abdomen  (and  body  generally),  both  the 
lymphatic  glands  become  enlarged,  and  the  small,  at  first 
pearly-white  and  then  yellowish  masses,  filled  with  lym- 
phoid cells,  called  tubercles,  stud  the  course  of  the  lym- 
phatic ducts.  As  the  disease  advances  the  latter  break 
down  and  form  small  cavities,  which  amalgamate,  the  giv- 


INFLAMMATORY    COXSUMPTIOX.  415 

ing  way  of  small  blood-vessels  as  a  result  of  this  process 
leading  to  the  ''  sjyitting  of  hlood^''  which  often  is  the  first 
indication  of  lung  mischief 

The  outlook  in  this  malady  depends  upon  the  stage  of 
the  disorder.  It  is  hopeful  in  the  early  stages  if  the  dis- 
ease is  local,  and  prompt  means  can  be  taken  to  improve 
the  health  and  to  supply  the  body  with  fats;  it  is  hopeless 
in  the  advanced  stages  and  when  once  the  body  at  large 
is  affected. 

Inflammatory  Consumption.  —  In  the  production  of  this 
form  of  phthisis,  scrofula  plays  not  the  primary,  but  only 
a  secondary  part. 

(a)  Inflammation  of  the  small  lobules  of  the  lung,  called 
"  catarrhal  or  lobular  pneumonia^''  commences  usually  as 
a  bronchitis  (catarrhal  bronchitis)  in  the  smaller  bronchial 
tubes  of  delicate  or  aged  people,  or  of  scrofulous  children 
whose  health  has  been  pulled  down  by  some  disorder,  such 
as  measles,  tchooping -cough,  etc.,  and  is  marked  by  the 
ordinary  symptoms  of  bronchitis — cough,  fever ishness,  etc. 
The  process  then  extends  from  the  bronchial  tubes  to  the 
surrounding  tissues,  and  the  lung  substance  itself,  here 
and  there,  becomes  inflamed.  One  of  two  things,  decided 
by  the  strength  of  the  sufferer,  may  now  occur :  either 
slowly  the  inflammatory  process  may  pass  away,  or  the 
inflamed  patch  may  break  down  into  a  cavity  which  may 
go  on  enlarging.  In  some  cases  the  lymphatics  may  take 
up  the  softened  inflammatory  matter,  and  general  tuber- 
culosis may  thus  all  at  once  arise. 

(^)  Inflammation  of  the  large  lobes  of  the  lung,  or  ordi- 
nary Pneumonia. — This,  the  common  form  of  '''' inflam- 
tnation  of  the  lungs,''''  usually  results  in  recovery,  but 
sometimes  the  softening  process  of  the  inflammatory 
products,  which  goes  on  towards  the  end  of  the  attack, 
may  end  in  the  formation  of  lung  cavities  and  phthisis. 


416  DISORDERS    OF    THE    LYMPHATICS. 

It  is  abundantly  clear  to  the  reader  that  inflammatory 
phthisis,  a  very  frequent  variety  of  the  disease,  is  quite  a 
different  disorder  in  causation  and  in  prognosis  to  the 
tubercular  form.  As  a  matter  of  fact,  the  majority  of 
the  cases  of  inflammatory  phthisis,  if  placed  under  favor- 
able conditions  for  health,  get  quite  well. 

Mechanical  Consumption  is  caused  by  a  breaking  down 
of  portions  of  the  lung  from  the  irritation  which  results 
from  the  inhaling  of  air  laden  with  certain  materials,  such 
as  coal-dust,  particles  of  steel,  etc.  "  Grinders'  rot  "  and 
"  coal-miners'  consumption  "  (anthracosis)  are  examples 
of  this  variety,  which  has  nothing  to  do  with  scrofula. 

Fibroid  Consumption  is  a  form  of  phthisis,  also  quite 
alien  to  scrofula,  the  result  of  the  increase  of  fibroid  tissue 
in  the  lung,  followed  by  contraction. 

Thus,  of  the  five  forms  of  consumj)tion,  the  chief  one  is 
a  disease  of  purely  scrofulous  origin;  the  variety  next  in 
importance  is  often  determined  though  not  caused  by 
scrofula;  while  the  third,  fourth,  and  fifth  have  no  rela- 
tion to  scrofula. 

Inherited  Syphilis. — I  have  already  stated  that  the  simi- 
larity between  constitutional  syphilis  and  scrofula,  both 
general  derangements  of  the  v^hole  lymphatic  system,  is 
very  great,  so  great  indeed  as  to  lead  many  pathologists 
to  regard  them  as  identical  in  origin,  and  congenital  sy- 
philis as  the  immediate  descendant  of  the  acquired  form, 
scrofula  a  more  distant  relation. 

There  are  certain  phenomena  in  infancy  and  childhood 
on  w^hich  a  strong  presumption  of  syphilis,  though  no  ab- 
solutely sure  diagnosis,  can  be  based,  since  scrofulous  and 
delicate  children  generally  may  exhibit  occasionally  simi- 
lar characteristics.  They  are  as  follows:  The  skin  at  birth 
is  usually  of  a  dull  color  and  the  features  are  contracted 
like  those  of  an  old  man.     Rashes  appear,  especially  on 


SYMPTOMS    OF    CONGENITAL    SYPHILIS.  417 

the  j9rt/^?25  and  soles,  but  often  also  all  over  the  body.  The 
child  fails  to  get  on,  and  usually  begins,  spite  of  all  care, 
to  icaste.  The  moist  parts  of  the  body — ^.  e.,  those  at  the 
angle  of  the  mouth,  at  the  nostrils,  between  the  buttocks 
and  thighs,  and  at  the  folds  of  the  joints — become  copper- 
colored  and  inflamed.  Snuffling  in  the  nose  is  distinct. 
Such  are  among  the  commoner  phenomena,  as  seen  in  the 
first  six  months  of  life,  which  may  lead  to  the  suspicion  of 
congenital  syphilis. 

As  life  advances  the  eyes  tend  to  become  affected,  some- 
times with  superficial  ulcerations,  sometimes  with  inflam- 
mations of  the  iris  and  cornea.  The  permanent  teeth  are 
often  peg-shaped  and  very  irregularly  set,  the  upper  incis- 
ors, and  sometimes  also  the  lower,  being  turreted.  Deaf- 
ness, the  result  of  disease  of  the  internal  ear,  is  not  un- 
common. A  tendency  to  sMn  disease  remains  throughout 
life. 

Consumption  of  the  tubercular  type  is  common  at  all 
ages  in  the  subjects  of  congenital  syphilis. 

As  life  advances  the  sufierer  loses  all  special  indications 
of  his  congenital  taint,  except,  of  course,  the  irregularities 
of  the  teeth,  and  becomes  to  all  intents  simply  scrofulous. 

Once  more  I  must  caution  my  readers  against  placing  too 
much  reliance  on  any  of  the  so-called  special  characteris- 
tics of  congenital  syphilis.  Any  cause  adverse  to  health 
in  a  pregnant  woman  will  result  in  the  birth  of  a  child 
bearing  all,  or  nearly  all,  such  pseudo-diagnostic  traits, 
although  no  taint  of  acquired  syphilis  may  exist  in  either 
parent,  such  adverse  maternal  cause  having  simply  brought 
into  prominence  in  the  infant  some  faint  scrofulous  family 
tendency  which,  under  more  favorable  conditions  of  de- 
velopment, has  appeared  in  no  other  of  her  children. 

The  treatment  of  congenital  syphilis  is  by  mercury.  The 
medical  man  has  practically  no  choice;  he  selects  in  the 
IS* 


418  DISORDERS    OF    THE    LYMPHATICS. 

after-consequences  of  mercury  a  lesser  evil  than  almost 
certain  death.  The  drug,  usually  administered  in  the  form 
of  gray  powder  (two  grains  of  which,  with  an  equal  quan- 
tity of  white  sugar,  being  placed  twice  a  day  on  the 
tongue),  has  a  marked  effect,  stimulating  and  rousing  the 
feeble  lymphatic  system,  and  admitting  thus  of  the  ab- 
sorption of  the  fats  in  milk-food,  of  the  expulsion  of  the 
morbid  materials  in  the  lymphatic  and  blood  streams 
which  have  caused  the  skin  to  inflame,  thus  advancing 
considerably  the  chances  of  life. 

The  mercury  should  be  gradually  discontinued  as  the 
symptoms  improve.  Then  general  measures  to  maintain 
the  bodily  health  must  be  had  recourse  to. 

The  reader  will,  no  doubt,  confounding  me,  perchance, 
with  the  blind  fanatics  who  shut  their  eyes  to  all  that  does 
not  square  with  their  fixed  preconceptions,  wonder  at  my 
recommendation  of  mercury  in  this  connection.  Let  such 
remember,  however,  that  no  material  is  either  good  or  bad 
in  the  abstract,  everything  being  relatively,  and  according 
to  the  conditions  present,  either  good  or  bad.  It  is  so 
with  mercury,  an  absolutely  bad  drug  in  the  vast  majority 
of  cases  of  acquired  syphilis,  in  which  there  is  neither 
danger  to  life  nor  to  any  important  organ,  and  in  which, 
therefore,  the  physician  is  quite  unjustified  in  mortgag- 
ing the  patient's  future  life  to  pay  off  debts  that  are  not 
pressing,  himself — the  ph3^sician — figuring  all  the  time  as 
a  philanthropist  who  has  found  the  money  himself  for  the 
purpose,  and  not  as  a  man  who  has  raised  a  loan  at  the 
expense  of  the  patient's  property  and  practically  without 
his  knowledge  or  sanction ;  but  in  congenital  syphilis,  and 
in  very  severe  acquired  forms,  the  case  is  altered:  the  pa- 
tient is  at  death's  door,  life  must  be  retained  at  any  sacri- 
fice, and  mercury  figures  no  longer,  therefore,  in  the  list 
of  evils. 


THE    SEQUEL JE    OF    STrHILIS.  419 

As  for  the  other  degenerations  affecting  the  lymphatic 
organs,  the  "  sequelce  of  syphilis  "  is  a  term  by  which  is 
meant  that  disorganization  of  the  lymphatic  system  due 
to  syphilis  and  which  persists  and  leads  to  a  great  many 
evils,  after  the  actual  fever  of  syphilis  has  passed.  This 
we  have  in  earlier  pages  discussed  as  "tertiary  syphilis." 
Zjeucocythoemia,  adenia,  and  Addison's  disease  are  disor- 
ders of  the  blood-forming  glands,  but,  as  the  chief  glands 
of  that  order  are  lymphatic  glands  as  well,  may  also  be 
reckoned  as  organic  degenerative  diseases  of  the  lym- 
phatic system.     They  have  been  already  described. 


CHAPTEK  XIY. 

DISEASES  DUE  TO  DEFECTS  IN  THE  ORGANS  OF  THE 

FOOD  SYSTEM. 

DISORDERS  OF  THE  SKIN  AND  KIDNEYS. 

FUNCTIONS  OF   THE   SKES". 

No.  1.  Skin  Diseases  due  to  Blood  Poisons. 

(a)  To  Micro-organisms. — The  fever  eruptions, 

(5)  To  Gout. — Eczema,  Acne  (red  and  simple  varieties),  etc. 

(c)  To  Syphilis. — Roseolous  Eruption;  some  varieties  of  Eczema,  of 

Ecthyma,  of  Lichen,  of  Pityriasis  and  of  Psoriasis ;  Rupia,  etc. 

(d)  To  other,  varioits,  impuriiies  : 

Affecting  the  Sweat-glands.  —  Hyperidrosis,  Dysidrosis,  Suda- 
mina. 

Affecting  the  Sebaceous  Glands  of  the  Skin. — Seborrhoea,  Come- 
dones, Acne  (of  some  forms),  Molluscum,  Boils,  Xanthe- 
lasma. 

Affecting  the  Hair  and  Wails. — Various  small  derangements. 

Affecting  the  Nerms  of  the  Skin. — Nettle-rash,  Prurigo,  Shingles. 

Affecting  the  Skin  Proper.— lAcliGn,  Erythema  nodosum,  Car- 
buncle. 

No.  2.  Skin  Diseases  due  to  Failure  of  other  Eliminating  Organs. 

(a)  To  Kidney  Failure. — Carbuncles,  Boils,  Prurigo,  Lichen,  etc. 

(b)  To  Lung  Failure. — Various  small  derangements. 

(c)  To  Liver  Failure. — Xanthelasma,  Prurigo,  etc. 

Ql)   To  Failure  in  Lymphatic  System. — Lupus,  Pemphigus,  Lichen 

Scrophulosorum,  Psoriasis,  Impetigo,  Pityriasis,  Ichthyosis. 
Unclassifiable   Skin  Affections. — Scleroderma,   Elephantiasis   (Lep- 
rosy). 


No,  3.  Skin  Diseases  due  to  Parasites. 

(a)  To  Vegetable  Parasites. — The  Ringworms. 

(h)  To  Animal  Parasites. — Phtliiriasis  (due  to  lice),  Itch. 

DISORDERS  OF   THE   KIDNEYS. 

Functional  Disorders. — Albuminuria,  Chyluria,  Haematinuria,  Phos- 
phaturia,  Inflammation  of  the  Kidneys,  Polyuria. 

Degenerations  of  the  Kidneys. — Chronic  inflammatory  Bright's  Dis- 
ease, Waxy  Bright's  Disease,  Fatty  Bright's  Disease,  Cancer  of 
the  Kidneys,  Scrofulous  Disease  of  the  Kidnej'^s,  Cj'^stic  Degen- 
eration of  the  Kidneys. 


XTbe   ffOOt)   Sl^Stem   {continued). 


CHAPTER   XIV. 

DISEASES  DUE  TO  DEFECTS  IN  THE  ORGANS  OF  THE 

FOOD  SYSTEM. 

V.  AND  VI.   DISORDERS  OF  THE   SKIN  AND  KIDNEYS. 

V.  DISORDERS  OF  THE  SKIN. 

Read  in  the  light  of  what  we  already  know,  the  dis- 
eases of  the  skin  will  present  to  us,  in  their  study,  no  great 
difficulties. 

The  skin  shares,  with  the  lymphatic  system,  the  kidneys, 
and  the  lungs  (and  to  a  slight  extent  also  with  the  liver), 
in  the  removal  of  ordinary  waste  material  from  the  body, 
and  in  the  elimination  therefrom  of  poisons.  The  derange- 
ments of  the  skin  produced  by  overwork  or  unaccustomed 
work  of  this  nature  are,  however,  evident  to  the  eyes  of 
the  flesh,  and  therefore  occupy  in  the  popular  estimation 
a  greater  place  than  do  those  of  the  other  eliminating  or- 
gans whose  lesions,  due  to  the  same  cause,  are  only  visible 
to  the  mental  gaze  of  the  physician,  though  none  the  less 
actually  present. 

Take  any  poison  you  choose,  say  that  of  scarlet  fever. 
You  witness  the  efforts  made  by  all  the  eliminating  organs 
to  get  rid  of  the  poisonous  products  of  fermentation  set 
up  by  the  micro-organism  in  the  body,  and  you  have  in 


424  DISORDERS    OF   THE    SKIX. 

nearly  every  case  tangible  evidence  in  the  skin,  lymphat- 
ics, and  kidneys,  and  often  in  the  lungs,  of  derangement 
resulting  from  the  strain. 

When,  therefore,  you  see  a  skin  eruption  of  any  kind  you 
know  it  can  be  but  due  to  one  of  three  causes — either 
to  a  poison  in  the  blood,  to  a  failure  of  one  of  the  other 
eliminating  organs  and  consequent  overwork  of  the  skin, 
or  to  a  parasite  that  has  temporarily  made  that  skin  its 
home. 

The  reader  will  at  once  be  tempted  to  ask  if  some  dis- 
eases of  the  skin  be  not  due  to  want  of  cleanliness  simply. 
The  answer  is,  that  uncleanliness  can  scarcely  ever  be 
viewed  as  a  primary  cause,  being  really  a  predisposing 
state,  which  determines  the  j*>rtr^  of  the  body  where  the 
skin  disease  will  appear,  or  appear  first  of  all.  If  the 
body  be  in  itself  sound  and  be  maintained  b}^  means  of 
exercise,  etc.,  in  good  health,  almost  any  quantity  of  dirt 
on  its  surface  can  be  well  borne. 

If  I  seem  to  devote  too  much  space  to  snch  explanations, 
it  is  merely  to  prevent  the  reader  from  leaving  the  broad 
lines  of  physiological  truth  and  getting  into  side  issues 
that  would  land  him  in  confusion. 

(1)  Skix  Disease  due  to  Blood  Poisons. 

{a)  Due  to  Micro-organisms. 

Under  this  heading  come  all  the  eruptions  which  char- 
acterize the  fevers. 

Their  stay  is  very  temporaiy.  They  are  evidences  of 
the  effort  made  by  the  skin  to  eliminate  the  products  of 
fermentation  set  up  by  the  micro-organisms,  and,  as  is 
conceded  on  all  hands,  it  is  well  to  adopt  such  measures  as 
shall  develop  them. 


GOUTY    SKIN    DISEASES.  425 

(b)  Due  to  Gouty  Poison  in  the  Blood. 

Of  these,  certainly  Eczema  occupies  the  most  prominent 
place.  Persistent  eczema  in  childhood,  when  not  due  to 
gross  overfeeding,  is  nearly  always  either  of  scrofulous  or 
gouty  origin.  In  the  vast  majority  of  those  cases  in  which 
it  forms  the  plague  of  middle  life  it  is  gouty  or  syphilitic; 
in  the  aged  it  is  almost  invariably  the  result  of  gout,  and 
is  rendered  at  that  stage  of  life  often  specially  intractable 
by  concurrent  failure  of  the  kidneys.* 

Eczema  is,  in  fact,  the  skin  disease  born  of  blood  impu- 
rities. It  is  developed  on  the  least  provocation  in  those 
whose  blood  is  surcharged  with  peccant  material.  Often 
a  plaster  applied  to  any  part  of  the  body  is  sufficient  to  de- 
termine an  attack,  which,  at  first  local,  gradually  becomes 
general. 

Eczema  takes  many  forms^on  the  face,  scalp,  and  body 
generally,  that  of  a  moist  sore,  which  subsequently  scabs 
over ;  on  the  lips  and  palms,  that  of  fissures ;  on  the 
tongue,  that  of  a  bright-red,  inflamed-looking  patch. 

Closely  allied  to  eczema,  sometimes  reckoned  as  a  vari- 
ety of  it,  we  have  Ecthyma,  which  assumes  the  form  of 
multiple  small,  hard,  distinct,  boil-like  excrescences  which 
scab  over. 

Acne  Rosacea  {Bed  Acne),  a  combination  of  acne  and 
eczema,  is  a  very  common  sequel  of  gout.  AYe  are  all  fa- 
miliar with  its  appearance,  for  it  is  the  skin  affection 
which  produces  those  bright-red,  inflamed  pimples  on  the 
face,  especially  on  the  cheeks  and  nose,  which  disfigure 
many  persons,  and  which  is  associated  in  the  popular  mind 
with  alcoholic  excess,  though  in  reality  many  who  are  and 
have  been  from  birth  total  abstainers  and  temperate  liv- 

*  Eczema,  plus  a  history  of  dyspepsia,  is  nearly  always  gouty. 


426  DISORDERS    OF    THE    SKIN. 

ers  suffer  from  it.  Alcoholic  excess  has  but  an  indirect 
relationship  to  it,  acting,  as  does  any  irritation  in  eczema, 
as  a  determinant,  not  as  a  primary  cause. 

The  common  form  of  Acne,  by  which  name  are  described 
the  pimples  which  at  puberty  appear  on  the  face  and 
across  the  shoulders,  and  which  so  often  distress  their 
possessors,  is  sometimes  of  gouty  origin. 

KettU-rash  and  Psoriasis,  diseases  to  be  presently  de- 
scribed, are  also  sometimes  the  offspring  of  gout. 

The  medical  reformer  who  shall  in  the  future  undertake 
seriously  to  sweep  the  Augean  stables  of  medical  treat- 
ment will  find  in  the  department  of  the  skin  a  large  share 
of  his  work.  He  will  see  the  eczemas  and  their  allies,  all 
speaking  witnesses  to  a  poison  in  the  system,  carefully 
pasted  over  and — silenced,  not  cured.  Eczema  and  its  al- 
lies are  brought  out  by  irritation,  and  they  can  be  made  to 
disappear,  at  least  for  a  time,  by  appropriate  soothing  ; 
but  the  patient  is  not  cured  or  even  benefited  by  this  ab- 
surd course,  while  not  unfrequently  he  is,  as  we  might 
expect,  rendered  seriously  ill,  for  the  acute  inflammation 
of  the  skin,  called  eczema,  often  takes  the  place  of  gouty 
inflammation  of  the  joints,  like  it  tending  spontaneously 
to  subside  when  it  has  rid"  the  system  of  the  uric  acid;  and 
to  paste  up  eczem-a,  to  "  drive  it  in,"  as  the  vulgar  say,  is 
on  a  par,  in  the  matter  of  wisdom,  with  the  application  of 
ice-bags  to  a  gouty  toe-joint. 

No,  whatever  poison  be  the  cause  of  the  eczematous 
enem}^  its  further  manufacture  in  the  body  must  be 
stopped  and  means  taken  to  prevent  its  re-accumulation 
ere  the  physician  can  be  entitled  to  take  to  himself  the 
credit  of  a  cure. 

If  gout  be  the  poison,  or  if  the  latter  be  apparently  the 
result  of  mere  excesses  in  food  or  in  certain  articles  of 
food — and  under  one  of  these  headings  nearly  all  eczema, 


GOUTY    SKIN    DISEASES.  427 

ectliyma,  and  red  acne  come — the  following  are  the  only 
roads  to  a  cure  : 

(1)  A  simple  and  sufficient  dietary  from  which  all  stimu- 
lating condiments,  all  "heating"  and  indigestible  sub- 
stances, must  be  eliminated.  Sometimes  it  is  necessary 
to  forbid  both  sugar  and  salt. 

(2)  The  avoidance  of  all  alcoholic  fluids. 

(3)  A  well-ordered  life  with  plenty  of  exercise  in  fresh  air. 

(4)  Suitable  clothing,  which  should  be  light  and  warm. 
Fine  merino,  silk,  or  unirritating  woollen  material  to  be 
worn  next  the  skin. 

(5)  The  functions  of  the  skin  to  be  well  attended  to. 
Warm  baths  (without  soap) ;  bran,  gelatine,  Or  weak  alka- 
line baths  are  useful  in  many  cases. 

(6)  Plenty  of  bland  fluid,  such  as  water,  to  be  consumed, 
and  plenty  of  fruit  to  be  eaten. 

(7)  Two  doses  of  some  mild  purgative  (Carlsbad,  Fried- 
richshall,  or  Hunyadi  water)  may  be  taken  in  half  a  pint 
of  hot  water,  before  breakfast,  twice  each  week. 

(8)  If,  after  adoption  of  these  measures,  there  is  still 
some  persistence  of  the  eruption,  a  simple  sedative  oint- 
ment or  powder,  such  as  one  of  the  following,  may  be 
employed  : 

Bismuth  Trisnitrate    ....     ^  an  ounce. 
Oxide  of  Zinc  Powder    ...     1  drachm. 

Lanoline  sufficient  to  make  a  perfectly  smooth  ointment. 
To  be  used  thrice  daily. 

Oxide  of  Zinc    ......     1  drachm. 

Bismuth  Trisnitrate    ....     1  ounce. 

Starch  Powder 1  ounce. 

To  be  dusted  over  the  inflamed  surfaces  twice  a  day. 

All  crusts  and  scabs  must  be  removed  by  soft -bread 
poultices  ere  ointment  or  powder  be  applied. 


428  DISORDERS    OF    THE    SKIN. 

If  the  eczematoiis  patch  be  old,  dry,  scaly,  and  thick- 
ened, a  stimulant  lotion  may  be  applied  to  it.     Thus : 

One  ounce,  each,  of  oil  of  cade,  of  soft  soap,  and  of  rec- 
tified spirit,  and  two  drachms  of  oil  of  lavender,  may  be 
mixed  and  well  rubbed  in  once  or  twice  a  day. 

Or,  two  drachms  of  solution  of  potash  (liquor  potassoe) 
may  be  added,  to  two  ounces  of  distilled  water,  and  Jirmli/ 
applied  for  half  an  hour  each  day  on  linen  till  the  scales 
soften  and  fall. 

In  acne  rosacea,  if  the  disease  be  well  established,  it  is 
often  useless  to  expect  a  cure  from  any  medication.  Equal 
parts  of  hazeline  and  lanoline  are  sometimes  of  use,  but 
obliteration  by  a  galvanic  point  of  the  small  dilated  arte- 
ries is  usually  the  only  local  measure  of  avail. 

I  repeat  once  more  that  ointments,  powders,  and  external 
applications  generally,  should  never  be  had  recourse  to  but 
to  remove  the  last  traces  of  irritated  skin  at  the  end  of 
general  treatment,  the  sole  local  treatment  in  the  earlier 
stag^es  beincj  directed  to  the  obviatino^  of  fresh  local  irrita- 
tion,  to  w^hich  end  no  soap  should  be  used  to  the  patches 
of  eczema,  which  should  be  protected  even  from  the  influ- 
ence of  air,  light,  and  friction. 

(c)  Due  to  Syphilis. 

From  a  disease  which  attacks  with  virulence  the  whole 
lymphatic  system,  almost  every  form  and  variety  of  skin 
affection  may  be  expected. 

This  expectation  is  abundantly  fulfilled  in  syphilis. 

In  the  first  stage  the  eruption  is  usually  roseolotis  and 
superficial,  akin  to  that  observed  in  measles  and  epidemic 
roseola. 

In  the  secondary  stage,  the  eruptions — for  they  are  gen- 
erally many — may  he  jmpular  (i.  c,  consisting  of  pimples), 
such  as  lichen  syphiliticus  ;   or  pustular  (^.  e.,  containing 


SYPHILITIC    SKIN    DISEASES.  429 

matter),  such  as  ecthyma ;  or  vesicular  (^.  e.,  containing 
clear  fluid),  as  eczema ;  or  even  squamous  [i,  e.,  covered 
with  scales),  as  pityriasis  or  psoriasis. 

In  the  tertiary  stage,  or  what  is  called  tertiary  syphilis — 
though  it  is  in  reality  only  a  stage  of  bodily  derangement 
consequent  on  the  damage  wrought  by  the  syphilis  which 
has  disappeared — almost  every  variety  of  skin  disease  may, 
in  different  persons  and  at  various  times,  be  AWtnessed. 
Miqna  is  the  only  one  which  can  be  said,  however,  to  have 
an  exclusive  claim  to  being  purely  syphilitic  in  origin. 
The  eruption  forms  elevated  reddish-hroicn,  cone-shaped 
ci'usts  on  the  skin,  and  when  it  heals  it  leaves  well-marked 
and  indelible  pitting  of  the  skin  behind. 

There  is  one  characteristic  whereby  nearly  every  syph- 
ilitic skin  affection  may  be  diagnosed,  a  peculiar  coppery 
or  reddish-yellow  hue  of  the  eruption  which  is  not  seen  in 
similar  but  non-syphilitic  forms  of  skin  affection. 

The  treatment  is  of  course  that  for  syphilis  ;  local  reme- 
dies are  scarcely  of  any  service,  though  sometimes,  in  the 
tertiary  stage,  strong  local  applications  of  the  most  potent 
caustics  must  be  had  recourse  to  to  hold  in  check  the 
advancing  destruction  of  the  skin  and  its  underlying 
tissues. 

(d)  Due  to  other  and  various  impurities,  and  classified 
according  to  structure  of  skin  specially  attacked. 

Affections  confined  to  the  Siceat  Glands  of  the  Skin. — 
Of  these  there  are  three  : 

Hyperidrosis,  an  excessive  secretion  of  sweat,  local  or 
general,  accompanied  often  with  decomposition  of  the  se- 
cretion.    This  is  most  common  in  the  feet. 

Dysidrosis,  or  diflSculty  of  sweating,  a  rare  complaint, 
the  retained  perspiration  causing  the  appearance  under 
the  skin  of  hard,  painful,  sago-like  grains,  a  state  of  matters 


430  DISORDERS    OF    THE    SKIN. 

usually  confined  to  the  palms  of  the  hands,  and  not  un- 
frequently  attended  by  constitutional  disturbances. 

Sudamina,  due  to  a  temporary  and  slight  retention  of 
the  sweat  which  is  secreted  in  excess,  the  retained  sweat 
forming  numberless  tiny  vesicles.  This  disorder  is  seen 
in  typhoid  fever,  in  consumption,  and  in  all  complaints 
attended  by  profuse  perspiration.  It  is  common  in  lying- 
in  women,  in  whom  the  red  flush  of  the  skin  and  the  slight 
constitutional  derangement  which  sometimes  accompany 
the  eruption  may  lead  to  a  mal-diagnosis  of  scarlet  fever. 
This  sweat  rash  used  to  go  by  the  title  of  '^  miliary  fever, ^"^ 
by  which  name  it  is  still  known  in  France. 

Dysidrosis  is  too  rare  a  disease  to  call  for  a  description 
of  its  treatment  at  our  hands  ;  sudamina  requires  no  treat- 
ment. The  only  one  we  shall  briefly  advert  to  again  is 
Hyperidrosis,  in  that  form  in  which  it  affects  the  feet,  the 
treatment  of  which  is  as  follows  :  New  stockings  must  be 
bought  and  frequently  changed.  The  stockings  used  when 
the  derangement  appeared  must  be  discarded.  Cork  soles 
should  be  worn  in  the  boots,  and  dusted  over  lightly  each 
day  with  boracic  acid  in  fine  powder.  The  feet  must  be 
well  washed  night  and  morning,  and  when  dried  carefully 
wiped  over  with  the  following  lotion  :  Tannin,  2  drachms; 
rectified  spirit,  2  ounces.  When  this  has  dried  in  they 
should  be  dusted  over  w^ith  powdered  asbestos  or  starch- 
powder.  The  boots  worn  must  be  easy  and  light,  and 
should  be  cut  low  to  admit  plenty  of  air  to  the  feot. 
The  above  treatment  is  simple,  cheap,  and  usually  eftica- 
cious. 

Affections  of  Sebaceous  Glands  of  Skin. — Of  these  there 
are  several. 

Sehorrhoea,  producing  a  peculiar  oiliness  of  the  skin. 
Common  in  women  who  suffer  from  menstrual  irregu- 
larities. 


DISEASES    OF    THE    SKIN,   HAIE,   AND    NAILS.  431 

Comedones,  by  which  name  are  described  the  small 
"black-heads"  so  common  on  the  face. 

Acne,  a  further  stage  of  the  last-mentioned  derange- 
ment. The  nodules  are  larger  and  red.  They  are  seen  on 
the  face  and  back  at  puberty,  and  sometimes  persist  to 
middle  life. 

Acne  rosacea,  a  further  development  of  the  same  state. 

Jloiluscum,  an  advanced  variety  of  acne,  the  pimples 
of  acne  being  here  replaced  by  wart-like  excrescences  which 
contain  a  milky  fluid,  which  is  capable  of  transmitting  the 
disease. 

Boils  (Furunculi). 

jLanthelasnia,  consisting  of  yellowish  patches  of  rough- 
ened skin,  connected  often  with  liver  derangement. 

The  treatment  of  seborrhcea,  comedones,  simple  acne, 
boils,  xanthelasma,  and  molluscum  resolves  itself  into  the 
adoption  of  measures  to  improve  the  general  health  ;  that 
of  acne  rosacea  has  already  been  discussed  under  the  head- 
ing of  gouty  skin  alBPections. 

Affections  of  the  Skin  Appendages  —  i.  e.,  of  Hair 

and  jVails. 

The  hair  may  become  dri/  and  fragile  from  lack  of  gen- 
eral health  ;  may  change  color,  from  age  or  local  nerve 
influence  ;  may  drop  out,  from  the  attack  of  vegetable 
parasites  or  from  constitutional  depression  —  e.  ^.,  from 
fevers — from  age,  and  from  hereditary  predisposition. 

The  nails  are  often  longitudincdly  grooved  in  gout,  trans- 
versely grooved  after  severe  acute  disorders,  clubbed  in 
scrofula  and  chronic  lung  disease  dependent  thereupon, 
fragile  and  softened  in  syphilis,  s/iec?  from  result  of  injury 
or  constitutional  disorder,  and  displaced  from  the  growth 
of  parasite  (e.  g.,  favus)  beneath  them. 


432  DISOKDEKS    OF    THE    SKIN. 

Affections  of  the  N^erves  of  the  Skin. 

Nettle-rash  (Urticaria). — Most  people  have  had  some  ac- 
quaintance with  this  disorder.  It  commences  suddenly, 
the  portion  of  the  skin  affected,  a  few  seconds  before  quite 
clear,  becoming  suddenly  the  seat  of  icheals,  resembling 
those  produced  by  a  nettle  sting,  but  larger,  which  cause 
an  intolerable  itching.  Sometimes  within  half  an  hour, 
and  nearly  always  Avdthin  half  a  dozen  hours,  the  whole 
eruption  has  disappeared. 

As  a  rule  nettle-rash  is  the  transient  and  unimportant 
disorder  such  as  I  have  sketched  ;  occasionally,  however,  it 
becomes  recurrent,  returning  again  and  again  at  short 
intervals,  and  ending  in  the  production  of  a  i^ermanent 
irritability  of,  and  a  persistent  crop  of  pimples  on,  the 
skin. 

It  is  often  due  to  the  presence  of  gouty  poison  in  the 
blood,  and  often  to  the  presence  of  other  and  various  poi- 
sons partaken  of  with  the  food,  or  actually  manufactured 
by  a  deranged  digestion  from  the  usual  nutrients.  The 
eatinsr  of  shell-fish  is  a  common  cause. 

It  is  common  in  childhood  and  in  adults  with  delicate 
skins,  in  the  gouty,  nervous,  and  rheumatic.  It  is  rarely 
of  any  special  significance,  but  sometimes  is  an  indication 
of  a  break-up  in  health. 

Treatment. — Of  the  transient  variet}^,  a  purge,  followed 
bv  a  slightly  lowered  and  cautious  dietary,  with  a  careful 
watch  for  any  one  article  which,  by  idiosyncrasy  of  the 
patient,  may  in  him  cause  the  eruption. 

In  the  chronic  variety,  all  treatment  often  fails.  If  gout 
be  suspected,  the  skin  disease  must  be  treated  as  an  off- 
shoot of  that  disorder  ;  if  the  nervous  system  be  depressed 
— and  this  is  frequently  the  case  in  this  variety — means 
calculated  to  improve  the  general  health  will  alone  avail. 


NETTLE-KASH    AND   PRUEIGO.  433 

Iodide  of  potassium  or  bromide  of  potassium,  either  of 
which  will  often  produce  this  skin  disease  in  those  free 
from  it,  are  the  best  drugs  to  relieve  symptoms. 

A  simple  but  efficient  lotion  to  relieve  the  itching  may 
be  made  of  equal  parts  of  glycerine  and  balsam  of  Tolu. 
It  should  be  painted  over  the  rash  with  a  fine  brush. 

Bran  baths  (infuse  4  lbs.  bran  in  2  gallons  or  so  of  boil- 
ing water,  strain  in  half  an  hour,  and  add  1  lb.  of  gelatine 
— fill  the  bath  up  with  hot  water  to  the  required  extent), 
soda  baths  (2  to  4  oz.  of  carbonate  of  sodium  to  be  added 
to  the  hot  water  of  this  bath),  or  creasote  baths  (one  to 
two  teaspoonfuls  of  creasote  mixed  with  an  ounce  or  two 
of  glycerine  to  be  added  to  the  ordinary  warm  bath), 
which,  if  they  afford  relief,  may  be  repeated  every  second 
day  for  a  time,  are  sometimes  of  avail  in  relieving  the  irri- 
tability of  the  skin.  All  coarse  flannels  worn  next  the 
skin  must  be  discarded  and  rej^laced  by  silk  or  non-irritat- 
ing and  fine  varieties  of  wool. 

Prurigo  is  a  term  under  which  are  comprised  all  condi- 
tions in  which,  without  any  apparent  external  cause,  and 
without  any  eruption  (or  at  most  a  fine  papular  one)  other 
than  that  which  results  from  scratching,  the  skin  in  larger 
or  smaller  areas  becomes  intensely  itching.  •  This  irrita- 
bility is  usually  worse  when  the  patient  becomes  hot. 

The  treatment  of  this  condition  is  to  seek  the  cause, 
which  is  often  not  far  distant,  and  to  remove  it.  In  pru- 
ritus vulvae  in  women  this  is  often  to  be  found  in  a  con- 
gestion of  the  neck  of  the  womb  ;  in  pruritus  scroti  in 
men,  often  in  gouty  gravel  lying  in  the  bladder  ;  in  pru- 
ritus ani  of  both  sexes,  the  irritation  of  thread-worms  is 
frequently  enough  at  the  root  of  the  mischief. 

In  the  aged,  parasites  are  a  common  cause  of  skin  irrita- 
tion, and  it  must  be  remembered  that  the  old  and  infirm, 
even  if  of  fairly  cleanly  habits,  are  prone  to  their  attacks. 
19 


434  DISOEDEKS    OF    THE    SKIX. 

Prurigo  is  common  in  jaundice  and  in  diabetes,  and  is 
due  then  to  impurities  circulating  in  the  blood. 

Herpes  Zoster  (Shingles). — An  affection  of  the  nerves 
which  suj^ply  the  skin  (and  the  muscles)  of  certain  regions 
of  the  body,  resulting  in  a  characteristic  eruption  of  groups 
of  red  pimples^  which  in  a  day  or  two  are  converted  to 
small  blisters  and  discharge  their  fluid,  forming  crusts 
which  fall  but  leave  no  scar  behind  them. 

As  a  rule,  the  disorder  does  not  last  more  than  ten  days, 
and  is  sometimes  ended  in  a  week. 

Shingles  often  appear  on  the  upper  lip,  on  the  genitals, 
or  above  the  eyebrow.  Wlien  occurring  on  the  trunk  of 
the  body  the  blister-like  patches  are  large,  and  usually  ar- 
ranged one  after  another  in  a  band,  extending  to  half  the 
circumference  of  the  body. 

Sometimes  severe  neuralgia  precedes  the  eruption,  and 
may  persist  for  long  after  the  latter  has  faded. 

Treatment. — Protect  the  inflamed  patches  from  irrita- 
tion. No  other  treatment  is  necessary,  the  disease  sub- 
sides of  its  own  accord,  and  its  duration  is  unaffected  by 
any  drug. 

Affections  of  the  Ski?i  proper. 

Lichen,  a  disease  of  the  skin  consisting  in  the  develop- 
ment of  irritable  xnmples  (papules)  commencing  in  limited 
patches  and  gradually  extending,  the  individual  pimples 
not  enlarging  and  but  rarely  suppurating.  The  disease  is 
not  attended  by  itching.  Lichen  is  a  rare  disease,  but  an 
exceedingly  troublesome  and  intractable  one. 

Its  cause  is  undoubtedly  alwaj's  to  be  sought  in  some 
blood  poison,  usually  the  product  of  mal-digested  food,  the 
result  of  chronic  ill-health. 

Treatment  consists  in  elevation  of  the  general  health  by 
exercise,  warm  baths,  simple  food,  etc. 


ERYTHEMA  NODOSUM  AND  CAKBUNCLE.       435 

The  only  drug  of  any  service  is  arsenic,  which  may  be 
administered  in  the  form  of  Fowler's  Solution  of  Arsenic 
in  three  to  five  drops  in  water,  thrice  daily,  after  food. 

Erythema  nodosum. — Has  no  relationship  whatever  to 
either  real  erythema  or  to  erysipelas. 

It  consists  of  elevated  red  "  bumps,''''  itching  or  painful, 
scattered  usually  over  the  front  of  the  shin-bone,  rarely 
seen  on  the  face  and  arms. 

Common  in  children  and  in  young  women.  Caused 
by  local  irritation  acting  on  impure  blood.  Not  unfre- 
quently  in  the  subjects  of  it  a  rheumatic  history  may  be 
traced. 

Treatment  of  any  sort  is  rarely  necessary.  Errors  in  diet 
and  in  mode  of  life  must  be  rectified,  and  perhaps  a  simple 
purge  may  at  first  be,  once  or  twice,  administered.  If  the 
swellings  be  painful  or  irritable,  one  drachm  each  of  chlo- 
ral, camphor,  and  menthol  may  be  rubbed  up  in  a  mortar 
to  make  a  fluid  which  may  from  time  to  time  be  painted 
over  the  swellings. 

Carbuncle  {Anthrax)  is  a  real  inflammation  of  the  skin, 
extending  to,  or  commencing  in,  the  underlying  layers,  and 
advancing  with  great  pain  and  constitutional  disturbance 
to  slow  suppuration. 

It  is  caused  apparently  by  various  blood  poisons,  and 
certainly  by  the  excess  of  sugar  in  the  blood  which  char- 
acterizes diabetes,  and  by  retention  also  in  that  fluid  of 
nitrogenous  debris  from  cells  which  the  kidneys,  from 
temporary  debility  or  from  chronic  disease,  are  unable, 
with  sufticient  rapidity,  to  eliminate. 

Unless  the  underlying  cause  be  promptly  found  and  re- 
moved, carbuncle  is  apt  to  recur  or  to  become  multiple, 
and  may  then  endanger  life. 

Treatment  must  be  directed  to  the  removal  of  the  blood 
contaminator.      The  carbuncle  must  be  protected  from 


436  DISORDERS    OF   THE   SKIN. 

irritation,  and  its  maturation  should  be  favored  by  hot  ap- 
plications, such  as  poultices. 

(2)  Skin   Diseases   due   to   Failure   of   other 
Eliminating  Organs. 

(ci)  To  Kidney  Failure. 

Hyperidrosis,  sudamina,  boils,  carbuncles,  prurigo,  xan- 
thelasma, lichen,  and  acne  are  often  directly  traceable  to 
kidney  failure,  and  occur  as  frequent  complications  in  the 
course  of  chronic  kidney  disease.  They  have  already  been 
discussed  under  the  head  of  poison-produced  skin  diseases, 
the  poison  in  cases  in  which  they  depend  on  kidney  failure 
being  nitrogenous  waste  retained  in  excess  in  the  blood- 
stream. 

{h)  To  Lung  Failure. 

Any  of  the  strumous  skin  disorders  to  be  presently 
enumerated  may  be  rendered  more  frequent  and  more  in- 
tractable by  the  presence  of  chronic  lung  disease. 

(c)   To  Lhier  Failure. 

To  some  extent,  by  the  way  of  the  hepatic  artery,  the 
liver  adds  eliminating  functions  to  its  other  manifold 
duties. 

Xanthelasma  and  prurigo  are  often  directly  traceable 
to  a  failure  in  its  eliminating  department. 

(c?)   To  Failure  of  the  Lymphatic  System. 

This  failure  is  almost  invariably  due  to  the  great  enemy 
of  this  system — scrofula. 

Of  diseases  already  described,  acne  of  the  simple  variety, 
comedones,  eczema,  and  ecthyma,  are  often  of  scrofulous 
dependency,  while  of  skin  diseases  more  exclusively  of  this 
origin  the  following  are  the  most  notable  examples : 

Lupus,  a  chronic  and  formidable,  but  non-contagious, 


LUPUS    AND    PEMPHIGUS.  437 

skill  disease,  affecting  especially  the  nose  and  cheeks,  near- 
ly always  of  scrofulous,  but  sometimes  of  syphilitic  cau- 
sation. 

It  commences  in  the  form  of  one  or  more  soft,  dull-red 
elevations,  often  covered  with  scales.  Two.forms,  distinct 
from  each  other  only  by  their  virulence,  are  known. 

Ulcerating  Z/upus.  —  In  this  variety  the  elevations  ul- 
cerate, and  the  ulcei'ation  spreads,  eating  away  sometimes 
a  part  of,  sometimes  the  entire,  nose. 

Non-ulcerating  Liipus. — In  this  form  the  elevations  do 
not  ulcerate,  or  do  so  only  to  a  slight  extent,  but  shrivel, 
leaving  white,  scar-like  patches  of  skin  behind. 

Treatment. — In  both  varieties  every  means  must  at  once 
be  taken  to  improve  the  general  health.  It  is  emphatic- 
ally not  a  disorder  to  be  trifled  with,  for  it  may  spread 
rapidly.  Of  local  applications,  the  non-ulcerative  form 
scarce  calls  for  any.  The  following  stimulating  applica- 
tion is,  however,  often  of  service  :  Take  of  soft  soap  4  oz., 
of  rectified  spirit  2  oz,,  of  rosemary  spirit  2  dr.  Mix  to 
form  a  lotion.  Pour  a  small  quantity  on  a  piece  of  flannel 
arid  rub  it  well  into  the  swellings  each  night,  applying 
afterwards  some  soothing  powder  (starch  -  powder,  tris- 
nitrate  of  bismuth,  etc.),  or  ointment  (ointment  of  the 
oleate  of  bismuth. 

The  ulcerative  form  must  be  actively  and  resolutely  at- 
tacked. The  patient  should  be  put  under  ether,  and  the 
ulcer  scraped  with  a  special,  sharp  spoon  or  destroyed  by 
electricity. 

Pemphigus. — A  skin  disease,  marked  by  the  appearance 
on  the  trunk  or  limbs  (rarely  on  the  face,  soles,  or  palms) 
of  isolated  round  blisters,  sometimes  two  or  three  inches  in 
diameter.  The  fluid  in  the  blisters  gradually  darkens  the 
blister,  which  finally  shrivels  and  disappears.  Pemphigus 
is  often  attended  by  slight  fever. 


438  DISORDEllS    OF    THE    SKIN. 

Usually  a  mild  complaint,  disappearing  spontaneously 
in  a  few  days,  but  sometimes  attended  by  great  nervous 
prostration  and  then  apt  to  be  serious. 

Relapses  are  not  uncommon. 

Caused  often,  but  not  always,  by  scrofula  or  syphilis. 

Treatment. — Anti  -  scrofulous  or  anti  -  syphilitic,  as  the 
case  may  require.  If  of  neither  origin,  the  disease  had 
best  be  left  alone,  for  its  course  is  then  not  likely  to  be 
favorably  affected  by  any  medicine. 

'  Lichen  Scrophulosorum. — A  rare  disease,  seen  only  in  the 
scrofulous,  and  marked  by  the  appearance,  generally  on 
the  trunk,  of  successive  croj^s  of  large  red  pimples 
(papules)  often  attended  by  swellings  of  the  contiguous 
glands. 

Treatment. — That  of  scrofula.  Local  applications  of  a 
soothing  nature,  ointment  of  the  oleate  of  bismuth,  or  car- 
ron  oil,  are  often  called  for. 

Psoriasis. — A  chronic,  non-contagious  skin  disease,  affect- 
ing mainly  the  arms  and  legs,  but  not  uncommon  on  the 
trunk  and  on  the  scalp,  appearing  often  as  a  fringe  to  the 
line  of  hair  surmounting  the  forehead. 

Characterized  at  first  by  the  appearance  of  large  circu- 
lar or  ovoid  red  patches  on  the  skin,  upon  which  fine  scales 
gradually  form. 

Caused  commonly  by  scrofula  and  syj^hilis,  but  not  un- 
frequently  of  independent  origin. 

Hemarlcs. — Psoriasis  is  a  common  skin  affection,  some- 
times terminating  in  a  fortnight,  but  more  often  per- 
sisting for  months  and  years,  and  recurring  when  driven 
back. 

Treatment  of  Chronic  Cases. — Improvement  of  general 
health.  Arsenic  (three  to  five  drops  of  Fowler's  Solution 
of  Arsenic  in  a  Avineglassful  of  water  thrice  daily,  after 
meals.) 


PSORIASIS,   IMPETIGO,    AND    PITYRIASIS.  439 

Local  measures. — The  following,  in  the  order  given,  are 
the  best  applications  : 

Chrysophanic  acid,  15  gr. ;  lard,  1  oz.     Mix. 
Pyrogallic  acid,  20  gr.;  benzoated  lard,  1  oz.     Mix. 
Thymol,  1 0  gr. ;  vaseline,  1  oz.     Mix. 

Such  ointments  are  useful,  and,  since  psoriasis  is  one  of 
the  diseases  most  difficult  to  rid  the  skin  thoroughly  of, 
are  often  used  with  justification.  They  should  be  applied 
twice  a  day  to  the  old  j)atch  or  patches  of  psoriasis  only, 
and  never  to  surrounding  skin,  nor  to  recent  patches,  nor 
to  eczematous  eruptions. 

It  must  be  added  that  though  the  chrysophanic -acid 
ointment  is  by  far  the  most  efficacious,  it  irremediably 
stains  the  under-clothing,  and  may  sometimes  produce  a 
considerable  amount  of  erythema. 

Impetigo.  —  An  acute  and  somewhat  contagious  skin 
affection,  commonly  seen  on  faces  of  scrofulous  and  ill-fed 
children,  and  sometimes  in  adults,  and  consisting  of  many 
single  or  clustered  pustules,  which  tend  to  run  together 
and  to  be  covered  by  a  thick,  yellowish  scab.  From  below 
the  scab  discharge  flows.  The  crusts  get  thicker  and 
larger  and  fall  off,  leaving  a  raw  surface.  It  is  accom- 
panied by  enlargement  of  the  neighboring  lymphatic 
glands. 

Confined  almost  exclusively  to  the  face  and  head. 

By  many  impetigo  is  reckoned  but  a  variety  of  eczema. 
The  treatment  is  the  same  in  both  diseases. 

Pityriasis  (Dandriff). — A  mild,  non-contagious  skin  affec- 
tion, marked  by  some  irritation,  and  the  production  on  the 
surface  of  fine  white  scales  that  separate.  Is  exceedingly 
common  on  the  scalp,  but  may  also  occur  in  reddish 
patches  on  the  body. 

Its  treatment  consists  in  the  adoption  of  measures  to 
improve  the  general  health.     Arsenic  in  small  doses  may 


440  DISORDERS    OF    THE    SKIX. 

sometimes  be  taken  with  benefit.  The  scales  may  be  re- 
moved by  soaking  the  affected  j)art  each  night,  for  three 
or  four  consecutive  occasions,  with  glycerine  of  borax. 
Washing  with  a  strong  solution  of  borax  and  hot  water 
will  sometimes  suffice. 

Ichthyosis  (or  Fish-skin). — A  chronic  skin  disease,  often 
congenital,  marked  either  by  a  dry,  harsh,  scaly  condition 
of  nearly  the  entire  skin,  or  confined  to  certain  portions, 
usually  the  legs  and  arms  only. 

The  size  of  the  scales  varies  much. 

Caused  often  by  scrofulous  or  syphilitic  hereditary 
taint. 

Treatment. — Xone. 

Four  Unclassifiahle  Skin  Affections. 

Fibrosis  of  Skin. — The  skin  may,  like  the  liver  and  the 
lungs,  become  the  seat,  often  without  apparent  cause,  of 
an  overo-rowth  of  fibrous  material.  When  occurrins:  in 
patches,  which  tend  to  spread,  it  presents  the  exact  ap- 
pearance of  a  scar  resulting  from  a  burn,  and  is  then  called 
scleroderma  /  when  it  attacks  not  only  the  face  and  hands, 
but  also  the  kidneys,  liver,  and  nervous  system,  it  is  called 
myxcedema. 

The  latter  form  is  a  very  grave  complaint,  terminating 
slowly  in  death  ;  scleroderma  is  much  less  dangerous,  but 
as  it  progresses  becomes  exceedingly  troublesome  and  re- 
sults in  great  deformity. 

Both  forms  of  this  disease  are  doubtless  caused  by  some 
constitutional  state  at  present  unknown,  and  both  are  be- 
yond the  reach  of  cure. 

Elephantiasis  of  the  Greeks,  or  Leprosy,  and  Elephantiasis 
of  the  Arabs,  are  two  skin  diseases  not  so  nearly  alike  in 
characteristics  as  to  justify  the  similarity  in  name.  Leprosy 
is  almost  certainly  of  the  nature  of  an  endemic  fever,  is 


ELEPHANTIASIS    AND    RINGWORMS.  441 

contagious,  and.  is  marked  by  the  formation  of  nodular 
patches  on  the  face  and  trunk,  which  tend  to  increase  in 
size  and  to  become  more  numerous,  causing  great  disfigure- 
ment (leonine  face).  The  disease  terminates  slowly  in 
death  by  exhaustion. 

The  Elephantiasis  of  the  Arabs  is  non-contagious  and  not 
endemic,  and  is  usually  limited  in  its  seat  of  attack  to  the 
legs  and  lower  abdomen,  the  skin  of  which  parts  becomes 
so  enormously  thickened  that  the  foot  and  leg  come  to  re- 
semble those  of  an  elephant. 

In  each  disease  has  a  special  micro-organism  been  found 
in  the  blood. 

The  utility  of  any  treatment  in  the  former  disease  is  a 
matter  of  great  doubt  ;  of  the  latter,  it  is  surgical,  some 
improvement  having  occasionally  been  effected  by  ligature 
of  the  main  blood-vessel  of  the  affected  limb. 

(3)  Skin  Diseases  due  to  Parasites. 

{ci)  Due  to  Vegetable  Parasites. 

Honeycomb  Ringworm  (Tinea  favosa). 

Caused  hy  the  growth  within  the  hair  follicles,  and  on 
the  skin,  of  a  fungus  called  the  AcJiorion  Schdnleinii. 

Characterized  by  inflammation  of  the  skin  of  the  affected 
part,  destruction  of  the  hair  of  the  region,  and  the  forma- 
tion of  a  succession  of  rounded  minute  cups,  the  whole  bear- 
ing a  strong  resemblance  to  a  honeycomb.  The  eruption 
has  a  peculiar  mousey  smell  which  is  quite  characteristic. 

Hemarks. — The  eruption  is  generally  confined  to  the 
scalp,  and  is  rare  in  England,  but  common  in  Scotland.  It 
often  results  in  permanent  baldness. 

Common  Ringworm  (Tinea  tonsurans). 
Caused  hy  the  growth  within  the  hair  follicles,  in  the 
19* 


442  DISORDERS    OF    THE    SKIN. 

substance  of  the  hair,  and  on  the  skin,  of  a  fungus  called 
Tricophyton  tonsurans. 

CharcLcterized  hy  the  formation  of  an  elevated  oval  or 
round  ring  of  inflamed  skin  which  spreads  at  its  margins 
and  is  paler,  and  often  a  little  scaly,  in  the  centre.  If  it 
affect  the  scalp  it  leads  to  patches  of  baldness,  the  hairs 
not  being  absent,  but  broken  off  short  near  the  skin. 

If  it  affect  the  beard^  moustache,  and  whiskers,  ring- 
worm assumes  a  distinct  appearance.  The  rings  formed 
are  then  not  complete,  but  run  together,  and  pustules 
form  at  the  roots  of  the  hairs,  which  do  not  fall  off  readily, 
but  are  so  loosened  as  to  be  easily  pulled  out.  Ringworm 
is  then  known  as  Sycosis.  It  is  communicated  commonly 
at  the  shops  of  lower-class  and  careless  barbers,  being 
carried  by  the  razors  in  use. 

Occurring  inside  the  thighs  and  on  the  back  of  the  neck, 
ringworm  will  often  assume  the  appearance  of  an  irregu- 
lar reddish  patch.^  whose  outline  is  formed  by  sections  of 
rings. 

Remarks. — The  form  that  attacks  the  hair  of  the  face, 
and  that  is  therefore  only  seen  in  adults,  is  exceedingly 
obstinate,  and  the  irritation  set  up  by  it  leads  often  to  a 
secondary  superimposed  eczema,  which  masks  the  real 
malady. 

Treatment  of  all  Varieties  of  Ringworm. 

{a)  Constitutional. — As  ringworm  rarely  attacks  any  but 
weak  or  scrofulous  individuals,  cod-liver  oil,  fresh  air,  and 
simple,  good,  nourishing  food  are  the  first  measures,  those 
without  which  many  cases  will  remain  intractable. 

In  a  parasitic  disease  local  measures  must,  of  course,  be 
had  recourse  to. 

In  honeycomb  ringworm  the  following  is  at  once  safe 
and  certain  : 


TREATMENT    OF    THE    EIXGWOEMS.  443 

Hyposulphite  of  Sodium     .     .     .     .     -^  ounce. 

Sulphurous  Acid ^  ounce. 

Distilled  Water 1  pint. 

This  may  be  ap]3lied  two  or  three  times  daily. 
All  scabs  are  to  be  gently  removed  by  means  of  soft, 
warm  bread  poultice,  and  all  affected  hairs  must  be  pulled 
out  with  proper  epilating  forceps.  The  looseness  of  the 
hair  renders  this  process  nearly  painless.  Absolute  clean- 
liness is  necessary,  and  the  wearing  of  a  soft,  light  linen 
cap,  which  should  be  changed  every  second  or  third  night, 
is  advisable,  at  least  at  night-time. 

In  simple  ringworm  much  discrimination  in  treatment 
is  necessary  to  effect  a  cure. 

If  it  occur  on  the  body,  one  brushing  over  y^\\hpure  car- 
bolic acid  usually  suffices ;  but  if  the  skin  be  delicate,  an  aj^pli- 
cation  every  third  or  fourth  day  of  equal  parts  of  glycerine 
and  carbolic  acid  is  to  be  preferred.  If  the  disease  appear 
on  the  seal}),  the  treatment  must  be  graded  to  the  condi- 
tion. In  any  case  the  liair  should  be  cut  everywhere  quite 
short,  and  the  whole  head  washed  once  a  day  with  strong 
borax  water  (^  oz.  borax  dissolved  in  a  cupful  of  hot  water). 
The  rest  of  the  treatment  will  depend  on  the  condition 
of  the  patches.  If  these  be  red,  and  have  been  inflamed 
by  strong  applications,  then  Coster's  j^aste  is  the  best.  It 
is  thus  made  :  Take  of  iodine  2  dr.,  and  dissolve  it  in  1  oz. 
of  decolorized  liquid  oil  of  tar.  The  patches  to  be  brushed 
over  with  this  once  every  four  or  five  days.  If,  however, 
the  patches  be  dry,  hard,  and  indolent,  the  following  is 
better:  Carbolic  acid,  2  dr.;  glycerine,  6  dr.  Mix,  and 
apply  with  a  brush  to  the  patches  each  night.  If  the 
broken  hairs  on  the  affected  patches  can  be  drawn  out 
easily,  it  is  best  to  do  so. 

In  mild  cases  the  ointment  of  the  iodide  oT  sulphur,  ap- 
plied tw^ice  a  day,  often  suffices. 


444  DISORDERS    OF   THE    SKIN. 

Tinea  Versicolor  (Liver  Spot). 

Is  caused  by  a  fungus  called  the  Microsporon  furfur. 

Characterized  by  the  appearance  of  yellow  patches,  cov- 
ered with  fine  branny  scales,  usually  on  the  front  of  the 
chest  and  abdomen,  tending  to  spread,  and  often  itching. 

Treatynent  is  as  follows: 

Once  a  day  the  patches  are  to  be  well  washed  and 
scrubbed  with  black  soap  or  carbolic  soap,  and  twice  each 
day  to  be  brushed  over  with  equal  parts  of  sulphurous  acid 
and  glycerine.  Small  quantities  only  of  this  lotion  should 
be  purchased,  as  it  is  essential  to  efficacy  that  the  sulphur- 
ous acid  be  fresh. 

ib)  Due  to  Animal  Parasites. 
Lice. — For  their  removal  from  the  hair  the  following 
lotion  is  singularly  efficacious: 

Corrosive  Sublimate 12  grains. 

Rectified  Spirit 1  ounce. 

Oil  of  Roses 1  drop. 

Distilled  Water,  up  to 6  ounces. 

Make  a  lotion:  label  "Poison." 

The  head  to  be  sponged  twice  a  day  with  this. 

Scabies  (Itch). 

Caused  by  the  presence  of  a  parasite  (the  Acarus 
scahiei)  which  irritates  the  skin,  and  the  female  of  which 
burrows  and  deposits  her  eggs  beneath  the  surface. 

Characterized  by  intense  itching,  which  becomes  worse 
as  the  body  becomes  warmer,  by  a  fine  eruption  of  pim- 
ples, most  marked  between  the  fingers  and  the  toes,  and  by 
tlie  appearance  of  the  tracks  formed  by  the  female  in  bur- 
rowing. 


TREATMENT    OF    SCABIES.  445 

Treat7ne}it.-^lE2Lc]i  night  a  hot  bath  is  to  be  taken,  and 
the  body  to  be  well  scrubbed  with  some  strong  soap,  after 
which  and  all  over  the  skin,  one  of  the  following  oint- 
ments or  lotions  is  to  be  well  rubbed  in: 

(1)  Liquid  storax,  4  oz.;  rectified  spirit,  1  oz.;  olive  oil, 
^  oz.     Mix. 

Or  (2)  Green  soap  and  lard,  of  each  1  lb.;  chalk,  4  oz. 
Mix. 

Or  (3)  Carbonate  of  potassium,  i  oz. ;  precipitated  sul- 
phur, 1  oz.;  simple  ointment,  4  oz. 

Three  or  four  applications  ought  to  cure.  The  clothes, 
bedding,  etc.,  ought  either  to  be  boiled,  or,  if  that  be  im- 
possible, to  be  thoroughly  cleansed  with  some  disinfectant. 
If  this  precaution  be  not  taken  the  parasite  will  return. 

We  have  now  completed  our  study  of  diseases  of  the 
skin,  and  it  is  clear  that,  under  the  classification  which  I 
have  adopted,  the  subject,  one  of  the  most  perplexing  for 
medical  men,  becomes  clear  and  intelligible. 

All  disease,  I  hold,  should  be  classified  according  to  its 
cause,  for  a  knowledge  of  the  latter  suggests  at  once  the 
real  measures  to  be  adopted  for  treatment.  But  before 
much  can  be  done  the  nomenclature  of  disease  must  be 
revised,  and  no  disease  in  future  ought  to  be  named  ac- 
cording to  a  prominent  symptom  only.  This  leads  to 
endless  confusion,  and  too  often  to  the  reduction  of  treat- 
ment to  a  foolish  contest  with  a  symptom,  which  itself  is 
a  benefit ! 

All  skin  eruptions  (except  the  parasitic  ones)  are  bene- 
fits to  the  diseased  hody  which  produces  them,  for  they 
do  not  occur  on  healthy  ones;  while  perhaps  even  for  the 
parasitic  ones  some  philosopher  of  the  future  may  find  a 
word  of  praise,  since  even  they  are  confined  almost  exclu- 
sively to  debilitated  and  already  disordered  subjects. 


446  DISORDERS    OF   THE    SKIN. 

The  sufferer  from  skin  disease  must  always  bear  in  mind 
that,  though  the  eruption  may  be  recent,  the  underlying 
cause  of  his  complaint  is  not  of  yesterday,  but  the  product 
of  years;  and  in  his  attempts  at  a  radical  cure  he  must  not 
expect  a  very  rapid  recovery,  though  if  he  be  content 
with  a  temporary  disappearance  of  a  symptom  of  his 
malady,  for  such  the  skin  erujjtion  is,  he  may  obtain  such 
questionable  benefit  often,  by  the  steady  use  of  unguents 
and  lotions,  in  the  course  of  a  few  days. 

VI.  DISORDERS  OF  THE  KIDNEYS. 

Functions  of  the  Kidneys. — To  se^^arate  from  the  blood, 
and  to  expel  from  the  body,  cell-waste  (represented  by 
urea  and  uric  acid),  together  with  water  and  certain  salts 
which  have  fulfilled  their  function  in  the  body. 

The  manner  in  which  this  is  done  is  simple  enough.  The 
water  and  probably  most  of  the  salts  are  simply  filtered 
through  the  fine  walls  of  the  capillary  blood-vessels  in  the 
kidney  and  pass  into  the  tubules  of  the  organ,  which  con- 
vey them  off.  The  urea  and  uric  acid  (and  perhaps  cer- 
tain of  the  simple  salts)  are  at  the  same  time  withdrawn 
from  the  same  fine  blood-vessels  by  the  action  of  the 
special  cells  which  form  the  walls  of  the  tubules. 

The  latter  function  may  be  regarded  as  the  special  duty 
of  the  kidneys,  as  certainly  it  is  the  most  important  one; 
it  can  be  performed  vicariously  and  efiiciently  by  no  other 
organ,  and  therefore  its  arrest  is  the  danger  to  be  feared 
in  kidney  disease,  the  body  in  such  a  case  being  poisoned 
by  its  retained  effete  matter. 

In  many  diseases  of  the  kidney  the  amount  of  water  and 
salts,  such  as  phosphates,  chlorides,  etc.,  may  be  through- 
out normal  or  even  constantly  in  excess,  and  as  a  result 
the  urine  will  be  clear,  even  clearer  than  normal,  while 
nevertheless  the  special  kidney  function  of  which  I  have 


THE    FUNCTIONS    OF    THE    KIDNEYS.  447 

spoken  is  becoming  slowly  arrested  and  leading  surely  to 
an  arrest  of  life. 

Ahnornially  clear,  limpid  urine  then  tells  us.  as  a  rule, 
nothing  of  any  importance  about  the  state  of  the  kidney, 
while  thick  urine  only  informs  us  that,  from  some  cause 
or  other,  probably  from  defective  blood  pressure  in  the 
kidney,  the  rehitive  amount  of  water  is  diminished.  The 
color  of  the  urine  tells  us  much  more  :  it  may  inform  us 
at  first  sight  tliat  certain  salts  are  being  passed  out  in  ex- 
cess, or  it  may  show  us  the  presence  of  a  foreign  element 
— e.  g.,  bile;  still,  even,  it  does  not  tell  us  what  we  would 
know,  the  amount  of  urea  present,  nor  does  it,  unless  uric 
acid  be  grossly  in  excess  of  the  normal,  inform  us  at  all  as 
to  the  amount  of  the  latter  substance  which  is  before  us. 

Chemical  analysis  and  microscopic  examination  alone 
are  competent  to  furnish  all  information  as  to  the  urinary 
constituents,  and  it  will,  very  often  indeed,  give  us  a  very 
complete  knowledge  of  the  patient's  general  health  as  well 
as  of  the  functional  activity  of  his  kidneys,  ere  yet,  per- 
chance, we  may  have  had  any  opportunity  of  seeing  and 
examining  him. 

It  is  impossible  in  the  very  limited  sj^ace  at  my  com- 
mand, to  discourse,  as  I  think  I  could  profitably,  and  cer- 
tainly would  willingly,  on  all  the  useful  indications  of  the 
general  state  of  the  body  to  be  read  in  an  analysis  of  the 
urinary  secretion,  and  I  therefore  am  compelled  to  restrict 
myself  to  short  observations  upon  certain  usual  and  un- 
usual ingredients  only.  Tlie  first  of  these  is  albumen.  We 
know  how  among  the  cells,  albumen — ^.  e.,  serum  albumen, 
together  wdth  various  salts — oozes  out  of  the  capillaries 
that  go  to  supply  them.  In  the  kidney  we  have  seen  that 
water  and  salts  only  thus  escape,  though  the  caj^illaries 
are  precisely  the  same  in  structure.  The  cause  of  this 
difference  is  to  be  found  in  the  blood  pressure  of  the  two 


448  DISORDERS    OF   THE    KIDNEYS. 

parts,  that  in  the  kidney  being,  in  health,  considerably  the 
lower.  But  albumen  does  occasionally  appear  in  the  urine 
and  constitutes  the  symptom  known  as  albuminuria — how 
can  this  arise?  Clearly  in  one  of  two  ways:  by  an  actual 
disease  in  the  kidnej^,  or  by  a  mere  increase  of  pressure  in 
the  capillaries,  the  result  of  an  (often  temporary)  increase 
in  heart  power.  It  may  even  occur  in  other  ways,  for  if 
the  digestive  system  be  not  in  first-class  order,  or  if  it  be 
overworked,  albumens  (e.  g.,  peptones)  that  transude  more 
easily  than  does  serum  albumen  may  be  present  in  the  blood- 
current,  and  thus  again  we  may  have  albuminuria,  more 
or  less  persistent  while  of  but  trifling  importance.  With- 
in late  years,  thanks  mainly  to  the  investigations  of  Pro- 
fessor Grainger  Stewart,  we  have  learned  that  albumi- 
nuria, far  from  being  in  itself  a  sign  of  kidney  disease,  and 
therefore  a  rare  symptom,  is  one  of  the  commonest  occur- 
rences in  the  life  of  healthy  persons.  When,  and  only 
%i'hen,  in  addition  to  albumen,  there  are  found  in  the  urine 
tlie  cells  of  kidney  tubules  or  portions  of  the  tubules 
themselves,  is  there  cause  for  alarm,  just  as  when,  in  lung 
disease,  with  the  sputum  expectorated  are  found  actual 
portions  of  the  lung  substance. 

What  we  have  seen  take  place  in  the  case  of  albumen 
may  and  does  also  occur  in  the  case  of  sugar,  with  this  dif- 
ference, that  organic  kidney  disease  does  not  increase  per- 
ceptibly the  output  of  sugar  by  this  channel.  Increased 
heart  pressure,  however,  has  the  same  effect  as  in  the  case 
of  albumen;  it  alone  is  often  enough  the  sole  cause  of 
glucosuria,  telling  as  it  does  both  on  the  liver,  where  the 
transformation  of  animal  starch  to  sugar  occurs,  and  on 
the  kidney  circulation. 

And  what  occurs  in  the  case  of  grape-sugar  may  even 
take  place  in  that  of  fat,  which,  in  an  emulsified  form,  or 
as  oil,  is  an  occasional  ing^redient  in  urine. 


STUDY    OF   THE    URINE.  449 

Blood-pigment,  with  a  few  red-blood  corpuscles,  may 
be  found  in  abundance  in  the  urine,  giving  it  a  strongly 
smoky  hue  (Haematinuria).  This  may  indicate  disease  of 
kidney  of  an  advanced  kind,  or  a  mere  exudation  of  blood, 
the  result  of  a  stone  in  the  kidney,  or  may  be  the  sequence 
or  concomitant  of  malarial  fever,  and  is  then  probably  due 
to  a  derangement  in  blood  formation,  the  outcome  of  those 
changes  in  the,  spleen  which  characterize  the  agues.  Even 
sometimes  mere  errors  in  diet,  exposure  to  cold,  or  exces- 
sive exertion,  may,  in  a  way  not  to  be  easily  accounted  for, 
produce  this  symptom.  The  outlook  and  the  treatment 
must  be  judged  of  by  the  cause. 

Chyle,  the  milky  fluid  found  normally  in  the  lymphat- 
ics, often  pinkish  in  hue  from  admixture  with  a  little 
blood-pigment,  will  sometimes  be  present  in  the  urine 
(Chyluria).  This  may  be  due  to  rupture  of  lymphatics  in 
the  kidney,  the  presence  of  a  parasite  (the  Filaria  sayi- 
gmnis)  in  the  blood,  or  disease  of  the  kidney  itself.  The 
outlook  is  generally  grave.  The  presence  of  fibrin,  which 
is  mingled  w^ith  the  chyle,  makes  chylous  urine  easily  co- 
agulable. 

I^hosj^hates  mnj  be  in  great  excess,  and  may  indicate 
merely  considerable  recent  brain-work  and  consequent  in- 
crease of  the  peculiarly  phosphatic  debris  of  nerve  cells, 
or  may  show  a  tendency  to  deterioration  of  the  nervous 
system.  In  the  latter  case  this  symptom  constitutes  a  lit- 
tle known  but  important  disease  (Phosphaturia),  which  is 
accompanied  by  general  depression,  laj^se  of  memory,  mus- 
cular exhaustion,  etc.,  but  which,  if  noticed  in  time,  may, 
by  the  adoption  of  measures  to  improve  the  general  health, 
be  cured.  As  a  temporary  condition,  phosphaturia  is  com- 
mon in  young  men. 

Tlt'iG  Acid  and  Urates. — Here  again  we  come  across 
uric  acid  and  its  salts,  the  urates,  which  in  health  are,  in 


450  DISORDERS    OF   THE    KIDNEYS. 

small  quantities,  normal  constituents  of  urine ;  wliicli, 
when  in  excess  of  the  normal,  indicate  surely  that  break- 
down known  as  gout,  but  gout  with  kidneys  active  enough 
to  keep  its  ordinary  symptoms  down;  which  again,  when 
deficient  in  amount,  after  having  been  present  in  excess, 
mean  a  temporary  strike  of  the  overworked  kidney  cells, 
retention  of  the  poison  in  the  blood,  and  approaching 
gouty  attacks  of  the  joints,  stomach,  skin;  upon  which, 
when  these  strikes  have  been  frequent  and  prolonged,  will 
ere  long  ensue  failure  of  the  renal  powers — in  other  words, 
gouty  Brighfs  disease,  and  slow  but  certain  poisoning  of 
the  body. 

Uric  acids  and  the  urates  are,  in  their  pure  state,  gen- 
erally amber-colored,  but  their  affinity  for  the  natural 
pigment  of  the  urine  transforms  them  usually  into  cay- 
enne-pepper-like or  brick-dust  deposits,  sand  or  gravel, 
which,  retained  in  the  kidney,  may  form  small  stones 
there,  and  thus  occasionally  lead  to  abscess  and  destruc- 
tion of  the  organ;  or,  passing  down  to  the  bladder,  may 
either  be  voided,  or,  remaining  in  that  cavity,  increase 
gradually  in  size. 

Of  other  abnormal  urinary  ingredients  may  be  noted 
bile-pigment  in  liver  derangement  and  jaundice,  pus  in 
abscess  of  the  kidney  or  of  other  parts  of  the  urinarj^  pas- 
sages, mucus  in  severe  bladder  derangements  and  fresh 
red  blood  from  the  bladder  or  urethra  in  some  acute  dis- 
orders. 

Functional  Disorders  of  the  Kidneys. 

With  most  of  these  we  have  already  dealt  in  discussing 
the  urine.     Two  only  remain  for  distinct  mention. 

(a)  Inflammation  of  the  Kidneys. 
A  rare  disease,  except,  as  following  on  sudden  check  to 


INFLAMMATION    OP    KIDNEYS    AND    POLYURIA.  451 

the  action  of  the  skin  in  the  drunken,  where  the  kidneys 
have  been  systematically  overworked,  or  in  the  fever- 
stricken,  gouty,  scrofulous,  or  otherwise  delicate,  in  whom 
the  kidneys  are  predisposed  to  disease  or  working  under 
difficulties. 

Characterized  by  shivering,  fever,  diminished  urination, 
marked  vomiting,  the  result  of  the  kidney  failure,  by  the 
appearance  of  alhimien  and  hlood  in  the  urine,  and  by  dull 
pain  over  the  lumbar  region. 

llesidting  in  favorable  cases  in  recovery;  in  other 
cases  in  death,  the  result  of  the  kidney  failure;  in  many, 
in  chronic  disease  of  the  organs  (chronic  inflammatory 
Bright's  disease). 

Treatment. — Assist,  by  frequent  hot  baths,  and  by  sub- 
sequent rest  in  hot,  dry  air,  the  action  of  the  skin. 

Leech,  blister,  cup,  or  persistently  poultice  the  lumbar 
region. 

Keep  the  diet  low,  especially  in  meat  and  its  prepara- 
tions, remembering  that  the  kidneys  are  working  badly; 
allow  plenty  of  hot  water  and  bland  diluents  to  assist  in 
washing  out  the  kidney  tubules.  Keep  the  bowels  in  free 
action. 

Be  exceedingly  cautious  not  to  stimulate,  by  means  of 
drugs,  the  kidney  functions. 

Give  ice  and  trisnitrate  of  bismuth  to  prevent  exhaus- 
tion from  excessive  vomiting. 

{b)  Polyuria, 

sometimes  misnamed  Diabetes  Insipidus,  is  a  condition  of 
the  kidneys  in  which  a  large  excess  of  water  only,  the 
other  constituents  hei^ig  normal,  transudes  from  these  or- 
gans and  is  voided. 

It  arises  from  a  dilatation  of  the  blood-vessels  of  the 
kidney,  the  result  of  defective  nerve-power,  and  is  analo- 


452  DISORDERS    OF    THE    KIDNEYS. 

ofoiis  to  the  condition  in  the  liver  which  is  a  cause  of  real 
diabetes.  It  exists  as  a  transient  state  in  hysterical  women, 
especially  towards  the  change  of  life,  and  is  sometimes  in 
men  the  sequence  of  great  mental  overwork  (as  is  fre- 
quently real  diabetes).  In  the  hysterical  it  is  generally 
quickly  recovered  from,  and  is  unattended  often  by  any 
secondary  symptoms;  in  other  cases  it  lasts  much  longer, 
and  is  apt  to  remain  as  a  permanent  condition,  producing 
as  its  consequences,  thirst,  debility,  gastric  and  intesti- 
nal derangements,  and  sometimes  an  excessive  craving  for 
food. 

ItemarJcs. — The  state  of  the  urine  in  polyuria  offers  a 
marked  contrast  to  that  in  diabetes,  for  in  polyuria  there 
is  neither  sugar  nor  albumen  nor  excess  of  urea  present  in 
the  water  passed. 

Treatment, — Avoid  causes  of  worry  and  great  mental 
effort.     Improve  the  general  health. 

Degenerations  of  the  Kidneys. 

Of  these  there  are  four  special  varieties,  known  from 
their  first  classifier.  Dr.  Bright,  as  Blight's  Diseases. 

(ct)  Degeneration,  the  consequence  of  preceding  kidney 
inflammation  (known  otherwise  as  chronic  inflammatory 
Bright,  gouty  kidney,  cirrhotic  kidney,  contracted  kidney, 
etc.). 

Of  this  form  there  are  three  subdivisions,  often  unneces- 
sarily separated  and  dealt  with  as  distinct  diseases,  the  dis- 
tinction being  based  on  the  locality  and  extent  of  the  in- 
flammatory process  which  has  set  on  foot  the  degeneration. 
Thus,  if  degeneration  succeed  to  acute  general  inflamma- 
tion of  the  tubules  and  fibrous  stroma  of  the  kidneys,  it 
is  styled  chronic  inflammatory  Bright;  if  it  succeed  to  a 
similar  inflammation  which  attacks  more  especially  the 
little  tufts  of  blood-vessels,  etc.,  the  so-called  "  Malpighian 


bkight's  diseases.  453 

bodies,"  and  is  the  result  of  scarlet  fever,  etc.,  it  is  styled 
"chronic  infective  inflammatory  Bright;"  while  finally,  if  it 
be  the  sequence  of  that  slow  inflammation  of  the  kidneys 
which  limits  its  ravages  largely  to  the  fibrous  stroma,  and 
Avhich  is  so  often  caused  by  gout,  it  is  known  as  "cirrhotic 
Bright"  or  " gouty  Bright." 

Each  of  these  subdivisions  of  chronic  inflammatory  kid- 
ney mischief  has  certainly  its  own  special  characteristic, 
but  all  agree  with  one  another  in  the  main,  and  may,  there- 
fore, be  grouped  together. 

This  disease  is  characterized  sometimes,  if  of  gouty  ori- 
gin, by  a  very  insidious,  and  sometimes,  as  in  the  other 
forms,  by  a  sudden,  commencement,  though  with  very  few 
exceptions  it  may  be  said  that  the  patient  is  usually  un- 
aware for  the  first  few  months,  or  even  years,  of  the  fact 
that  any  grave  kidney  lesion  is  present.  Signs  of  dyspep- 
sia^ headache^  a  marked  tendency  to  perspire^  pallor  of  the 
skin,  and  a  bloated  appearance  of  the  hands,  and  particu- 
larly of  the  lower  eyelids,  and  palpitation,  are  perhaps  in 
that  period  of  comparative  health  occasional  symptoms. 
Then  are  witnessed  fairly  frequent  attacks  of  acute  stom- 
ach derangement,  accompanied  by  severe  retching,  and 
commencing  without  assignable  cause,  but  often  preceded 
or  accompanied  by  a  marked  temporary  decrease  in  the 
amount  of  urine  secreted.  The  heart's  action  continues 
violent  and  ancemia  advances.  Dropsy  is  rarely  2^i'omi- 
nent,  except  in  a  very  mild  form  and  quite  towards  the 
end.  The  nervous  system  becomes  affected,  and  not  un- 
frequently  there  are  witnessed  violent  convidsions.  The 
eyesight  becomes  impaired.  Finally  the  patient  dies,  usu- 
ally from  some  secondary  mischief,  such  as  pleuris]/,  ery- 
sipelas, bronchitis,  ov  pneumonia. 

Such  is  a  very  brief  and  general  sketch  of  a  disease 
which  may  extend  oyer  fifteen  or  twenty  years,  and  which 


454  DISORDERS    OF    THE    KIDNEYS. 

acts  hj  poisoning  slowly  the  whole  body  by  the  gradually 
increasing  barrier  it  opposes  to  the  passage  from  the  body 
of  nitrogenous  waste.  This  retention  within  the  body  of 
urea  is  styled  uraemia. 

(b)  Degeneration  of  the  waxy  form ^  the  consequence  of 
prolonged  bodily  weakness  (known  as  waxy  Bright's  dis- 
ease). 

In  the  strict  sense  of  the  word  this  is  not  a  kidney  dis- 
ease proper,  but  is  a  mere  local  manifestation  in  the  kid- 
ney of  waxy  degeneration  proceeding  more  or  less  gener- 
ally throughout  the  body. 

Characterized  by  a  history  of  severe  syphilis,  of  bone 
disease,  of  prolonged  and  exhausting  discharges,  or  of 
long-continued  illness  of  other  forms,  and  marked  by  an 
increased  flow  of  clear  urine  that  always  contains  albu- 
men, by  gradual  decrease  of  strength  and  great  anaemia, 
and  often  by  many  signs  of  disease  due  to  degenerative 
changes  proceeding  throughout  the  body. 

Resulting  slowly  in  death, 

(c)  Degeneration  of  the  fatty  form,  the  consequence  of 
bodily  weakness  and  of  mal-nutrition  (known  as  fatty 
Blight's  disease). 

Like  the  preceding  complaint,  fatty  Bright's  disease  is 
not  a  kidney  disease  in  the  real  sense  of  the  word,  but 
only  one  portion  of  a  general  bodily  degeneration. 

Characterized  by  rapidly  increasing  debility  and  pallor, 
often  combined  with  a  pufiiness  of  the  face  and  whole 
body,  by  frequent  micturition,  the  urine  being  generally 
clear  and  lim2:)id,  but  always  markedly  albuminous,  dys- 
l^epsia,  attacks  of  severe  vomiting,  and  a  gradual  loss  of 
eyesight.  Towards  the  end,  convulsio?is  and  general  drop- 
sy, which  extends  to  the  internal  organs,  and  esj^ecially  to 
the  lungs,  pleura?,  and  pericardium,  and  thus  terminates 
life,  is  the  common  sequence  of  events. 


TREATMENT    OF    KIDNEY    DISEASE.  455 

The  treatment  of  all  forms  whatever  of  kidney  degener- 
ation resolves  itself  simply  into  the  adoption  of  measures 
to  prolong  life.  The  skin  and  lungs  must,  of  course,  be 
kept  in  good  functional  activity,  and  therefore  the  patient 
should,  if  possible,  seek  in  winter  a  warm  climate.  The 
skin  must  be  clothed  with  silk  or  flannel.  The  diet  must 
be  sufficiently  nourishing,  while  not  being  too  nitrogenous. 
Bland  fluids  may  be  taken  to  any  extent,  and  occasionally 
a  mild  diuretic  mineral  water,  such  as  that  of  Contrexe- 
ville  or  of  Eviens,  is  called  for.  Alcohol  must  be  imbibed 
with  great  caution.  The  bowels  are  to  be  maintained  in 
functional  activity. 

Among  other  organic  diseases  of  the  kidney  are  reck- 
oned Cancer,  the  symptoms  of  which  are  pain,  plus  the 
other  general  signs  of  kidney  failure.  Unlike  the  degen- 
erations w^e  have  discussed,  it  attacks  at  first  but  one  kid- 
ney. Strumous  disease  of  the  kidney  is  spoken  of  by  most 
writers  as  a  special  degeneration,  and  it  has  certainly  the 
same  claim  to  that  designation  as  have  fatty  and  waxy 
Bright's  disease,  being,  like  them,  the  local  expression,  in 
what  happens  in  the  patient  to  be  the  Aveakest  part  of  the 
body,  of  a  general  scrofulous  degeneration.  Its  symptoms 
are  those  of  fatty  Bright's  disease,  but,  as  a  rule,  are  more 
severe  and  more  quickly  fatal.  It  attacks  simultaneously 
both  kidneys.  Cystic  degeneration  of  the  kidneys,  a  state 
of  matters  in  which  a  number  of,  usually  small,  cysts  form 
in  the  kidneys,  is  yet  another  disease  sometimes  seen,  and 
due  usually  to  a  blocking  of  the  tubules  of  the  kidneys 
and  a  resulting  expansion  of  them. 

Finally,  hydatid  cysts,  containing  numberless  immature 
tapeworms,  may  form  in  the  kidneys,  as  in  the  liver  and 
other  organs  of  the  body. 


CHAPTER  XV. 

DISEASES  DUE  TO  DEFECTS  IN  THE  ORGANS  OF  THE 

FOOD  SYSTEM. 

Disorders  of  the  Lungs,  Throat,  and  Windpipe. 

FUNCTIONS  AND  STRUCTURE  OF  THE  LUNGS. 

Functional  Disorders  of  the  Lungs  : 

(a)  Broncliitis  (coarse  variety). 

(b)  Bronchitis  (fine,  capillary  form). 

(c)  Pneumonia. 

(d)  Pleurisy. 

Degenerations  of  the  Lungs : 

Consumption  (tubercular  form). 

"  (inflammatory  form). 

"  (fibroid  form). 

Cancer. 
Mortification. 
Abscess. 

Other  Conditions  of  the  Lungs : 

Asthma  (a  nerve  derangement). 
Bronchiectasis  (a  dilatation  of  the  bronchial  tubes). 
Emphysema  (a  dilatation  of  the  air-cells). 
Collapse  (a  mechanical  arrest  of  function). 
Congestion  (a  transient  or  permanent  condition  of  the  cir- 
culation). 
Ha3moptysis  (a  symptom). 

Disorders  of  the  Throat : 

Derangements  of  the  tonsils. 

The  inflamed,  relaxed,  or  congested  throat. 

Disorders  of  the  Larynx : 

Inflammation  of  the  larynx  (in  children  productive  of  real 

croup). 
Congestion  of  the  larynx. 
Spasm  of  the  larynx  (false  croup). 
20 


XT  be   ff005    ^>^5tCm— {continued). 


CHAPTER  XV. 

DISEASES  DUE  TO  DEFECTS  IN  THE  ORGANS  OF  THE 

FOOD  SYSTEM. 

VII.  DISORDERS  OF  THE  LUNGS. 

The  functions  of  tlie  lungs  are  twofold.  Firstly,  they 
assist  in  removing  carbonic  acid  and  water,  the  products 
of  the  combustion  of  fuel-food,  from  the  body;  and,  sec- 
ondly, they  replace  the  carbonic  acid  thus  withdrawn  by 
oxygen,  by  means  of  which  gas  the  combustion  of  all  food 
within  the  body  is  performed. 

Of  what  vital  importance  then  to  man  is  a  healthy  state 
of  the  breathing  apparatus,  and  to  what  general  disaster 
will  not  even  a  trifling  breakdown  of  it  lead  ! 

Lessen  by  ever  so  little  the  power  of  the  lungs  to  take 
up  oxygen,  and  at  once  all  the  processes  of  life  suffer  a  pro- 
portionate arrest. 

And  yet  how  easily,  and  from  how  many  quarters,  may 
derangement  attack  the  lungs  !  Rich  in  lymphatic  ducts 
and  glands,  and  enveloped  in  large  lymphatic  cavities  (the 
pleurae),  scrofula.^  sypJiills,  rheumatic  fever,  and  every  de- 
rangement that  tells,  directly  or  indirectly,  on  the  lym- 
phatic system,  threaten  their  integrity  from  a  thousand 
points  ;  while  every  poison,  living  or  inanimate,  that  cir- 


460  DISORDERS    OF    THE   LUNGS. 

dilates  in  human  blood,  must  many  hundred  times  a  day 
pass  through  their  delicate  meshwork  of  air-cells,  which 
they  rarely  fail  to  disorder  and  sometimes  to  destroy. 

But  more  than  this  :  the  lungs  depend  directly  for  a 
regular  blood  supply  on  the  perfection  of  the  heart,  one 
half  of  which  latter  organ  is  constantly  engaged  in  sup- 
plying them  with  the  vital  fluid,  while  the  other  half  is 
occupied  in  receiving  it  as  it  comes  back  re-oxygenated, 
and  in  pumping  it  to  the  body  at  large.  A  diseased  heart, 
then,  must  mean  a  hampered,  and  in  time  a  diseased,  pair 
of  lungs. 

Once  more  :  the  lungs  give  off  water  vapor,  actually 
visible  to  us  in  cold  weather,  and  the  kidneys  and  skin 
are  also,  among  other  duties,  engaged  in  the  same  w^ay. 
Check,  then,  suddenly  the  action  of  either  of  the  latter 
organs,  as  is  so  often  done  by  allowing  the  sudden  impact 
on  a  large  surface  of  the  body  of  cold  air,  or,  still  worse, 
as  further  impeding  skin  transpiration,  cold  and  damp 
air,  and  you  have,  as  a  very  natural  consequence,  increased 
duty  thrown  on  the  lungs,  and,  unless  these  latter  organs 
are  in  first-rate  working  condition,  you  engender  very 
easily  some  one  or  other  of  the  forms  of  lung  disease. 
Cold  and  damp  are,  then,  not  actual  first  causes  of  lung 
affection,  but  are  the  developing  agents,  bringing  out  in 
the  delicate  generally,  and  especially  in  the  scrofulous  and 
in  those  not  habituated  to  the  influences  of  damp  and 
cold,  lung  disorders,  due,  of  course,  to  pre-existing  weak- 
nesses there,  weaknesses  which,  with  care  and  prudence, 
might  never  have  appeared  to  threaten,  and  perhaps  de- 
stroy, a  life  that  was  with  difliculty,  before  the  attack, 
facing  the  dangers  that  menaced  it. 

A  word  as  to  the  structure  of  the  lungs.  Imagine  a 
short  bush,  the  smaller  twigs  of  which  are  crowded  with 
leaves  ;  imagine  the  trunk,  branches,  and  leaves  to  be  all 


THE  GENESIS  OF  LUNG  AFFECTIONS.        461 

hollow,  and  if  you  call  the  short  trunk  the  trachea,  the 
large  branches  the  big  bronchial  tubes,  the  twigs  they 
give  off  the  small  bronchial  tubes,  and  the  hollow  leaves 
in  which  they  terminate  the  air  -  cells,  you  have  a  very 
complete  idea  of  a  lung,  such  as  it  would  appear  if  sud- 
denly cut  in  half  Avhen  full  of  air,  excepting  that  all  the 
space  between  each  branch  or  branchlet  and  between  each 
leaf  is  filled  in  with  blood-vessels,  lymphatic  ducts,  and 
that  fibrous  binding  material  which  here,  as  everywhere 
else- in  the  body,  surrounds  and  maintains  firmly  in  each 
place  each  and  every  other  tissue. 

Xow,  disease  may  commence  in  any  one  of  the  above 
parts  ;  if  it  be  of  an  inflammatory  nature,  and  it  attack 
the  trachea  and  big  bronchial  tubes,  it  is  called  Coarse 
Bronchitis ;  if  it  attack  the  smaller  tubes.  Fine  Bronchitis ; 
if  it  attack  the  air-cells  and  the  binding  material  with  its 
contained  lymphatics  and  blood-vessels,  it  is  called  inflam- 
mation of  the  lungs,  or  Pneumonia;  while,  if  it  attack  the 
large  lymph  sacs  (the  pleurte)  in  which  the  lungs  rest,  it  is 
called  Pleurisy. 

If  the  disorder  be  of  a  degenerative  type,  and,  as  in 
scrofula,  be  located  first  in  the  lymphatic  ducts  and  glands 
external  to  the  bronchial  tubes  and  air-cells,  which  then 
ulcerate  and  break  down,  it  is  called  Tubercular  Phthisis 
(or  rapid  consumptioii)  ;  if  it  be  situated  mainly,  or  in- 
deed solely,  in  the  fibrous  binding  material,  which,  when 
inflamed  in  any  part  of  the  body,  first  swells  and  then 
shrinks  and  strangles  all  that  it  envelopes,  it  is  called 
Fibroid  Phthisis;  if  it  be  the  consequence  of  severe  in- 
flammatory disorder  of  the  nature  of  fine  bronchitis  or  of 
pneumonia,  it  is  styled  Inflammatory  Phthisis. 

As  other  examples  of  degenerative  type  we  may  have, 
but  rarely,  Cancer  of  the  Lung,  Abscess  of  the  Lung,  or  Mor- 
tification of  the  Lung. 


462  DISORDEES    OF    THE   LUNGS. 

Then  a  derangement  of  the  nerv'e  mechanism  of  the  lungs 
may  produce  disorder,  a  variety  of  spasm  of  the  bronchial 
tubes,  known  as  Asthma.  An  over-stretching  and  perma- 
nent dilatation  of  the  air-cells  and  bronchial  tubes,  sec- 
ondary results  of  many  lung  disorders,  especially  of 
chronic  asthma,  are  called,  the  first  Emphysema,  the  sec- 
ond Bronchiectasis.  Then  we  have  the  rare  condition  of 
Collapse  of  a  portion  of  the  lungs,  due  to  block  of  the 
main  bronchial  tube  going  to  it. 

A  state  of  Congestion  of  the  Lungs  is  an  exceedingly 
common  one,  and  indicates  a  mere  over-supply  of  blood 
to  the  lung  ;  this  may  arise  from  some  temj^orary  cause, 
and  be  of  no  consequence  ;  may  indicate  the  first  com- 
mencement of  pneumonia,  and  mean  coming  mischief  ;  or 
may  be  quite  chronic,  and  due  then  usually  to  imperfect 
action  of  the  heart,  in  which  case  it  will,  though  but  slowly 
and  gradually,  lead  to  death,  or  contribute  to  a  fatal  ter- 
mination. 

We  are  now  fairly  in  position  to  understand  and  aj^pre- 
ciate  the  influence  of  apparently  different  causes  in  the 
production  of  each  single  disease  of  the  breathing  appara- 
tus, and  therefore  to  render  necessary  but  a  comparatively 
brief  and  simple  description  of  the  sj^ecial  characters  of 
each  one. 

The  Functional  Disorders  of  the  Lungs. 

(1)  Bronchitis,  of  the  ordinary  coarse  variety,  affecting 
the  larger  bronchial  tubes  only  or  mainly. 

This  disease  varies  greatly  in  severity,  from  a  mere  light 
bronchial  catarrh,  recovered  from  in  a  few  days  and  often 
seen  in  really  healthy  persons  who  take  a  little  too  much 
care  of  themselves,  and  who  therefore  contract  this  affec- 
tion from  a  comparatively  slight  indiscretion,  up  to  severe 
acute  bronchitis,  the  expression  of  some  long -tolerated 


BRONCHITIS.  463 

impurity  or  impurities  in  the  blood  and  threatening  life 
by  the  high  fever  it  produces  and  the  grave  impediment 
it  offers  to  the  efficient  action  of  the  lungs,  brought  out 
by  a  slight  chill,  or  perhaps  developing  without  even  that 
provocation. 

It  must  always  be  borne  in  mind  that,  whenever  there 
is  poison  in  the  blood,  whatever  be  its  nature,  there  is 
grave  danger  of  bronchitis,  or  of  other  inflammatory  lung 
affection,  and  that  a  very  slight  exposure  then  suffices  to 
its  production. 

There  are  three  characteristic  stages  in  bronchitis. 

First  Stage.— In  this  stage  the  mucous  membrane  of 
the  bronchial  tubes  is  red,  swollen,  and  congested,  and,  as 
a  consequence,  we  ha\e  feverishness,  a  sense  of  raioness 
behind  the  breast-hone,  qidch  breathing,  and  a  dry,  fre- 
quent cough.  Sometimes  in  this  stage  there  is  a  marked 
sense  of  suffocation. 

Second  Stage. — In  this  stage,  which  in  a  day  or  two 
succeeds  the  first,  the  mucous  membrane  begins  to  exude 
at  first  thin,  seroiis-looJcing  fluid,  and  then  mucus,  with 
which  comes  a  sense  of  relief,  all  the  symptoms  improving, 
the  cough  becoming  less  frequent,  less  tickling,  and  moist  j 
the  expectoration  of  mucus  every  day  growing  easier. 

Third  Stage. — In  this  stage  the  exudation  from  the  mu- 
cous membrane  of  the  bronchial  tubes  becomes  even  more 
copious,  being  sometimes  yellow  or  green.  There  is  in 
favorable  cases  a  further  relief  in  this  stage  from  urgent 
chest  sj^mptoms,  but  debility  is,  as  we  might  indeed  ex- 
pect, more  marked. 

The  three  stages  usually  last  from  a  week  up  to  a  month 
or  so,  when  convalescence  slowly  sets  in. 

In  many  cases,  however,  especially  in  the  aged  and  bro- 
ken-down, or  in  the  unhealthy,  the  stage  of  convalescence 
is  never  reached.     In  them  the  symptoms,  with  care,  may 


464  DISORDERS    OF   THE    LUNGS. 

ameliorate,  becoming  less  urgent  and  troublesome,  but  ac- 
tual recovery  does  not  take  place,  the  patient  improving 
in  warm,  dry  air  and  with  suitable  food,  to  relapse  again 
under  adverse  conditions.  This  is  called  Chronic  Bronchitis. 

The  prognosis  in  bronchitis  depends  on  the  underly- 
ing cause  of  the  attack,  the  extent  of  the  disease,  and  the 
strength  of  the  patient.  According  to  these,  bronchitis 
may  mean  much  or  little.  In  the  subjects  of  kidney  dis- 
ease, in  those  attacked  by  malignant  fevers,  and  in  the 
diabetic,  bronchitis  often  means  the  beginning  of  the  end; 
in  the  gouty,  the  rheumatic,  the  aged,  the  scrofulous,  etc., 
often  prolonged  and  recurrent  trouble ;  in  the  young  and 
vigorous,  but  a  month's  confinement  to  the  house,  to  be 
followed  by  complete  recovery. 

Treatment. — In  a  disease  of  which  the  actual  causation, 
the  enemy  to  be  removed,  is  often  of  such  different  char- 
acter, it  is  impossible  to  speak  of  treatment  but  in  general 
and  guarded  terms. 

Above  everything,  the  amateur  physician  must  remem- 
ber that,  except  in  the  grave  cases  when  no  medicinal 
treatment  avails  aught,  bronchitis  tends  of  its  own  accord 
to  recovery,  and  that  ill-judged  and  excessive  medication 
only  impedes  this  process. 

The  following  measures  are,  however,  alicays  good  : 

In  the  first  stage^  keep  the  patient  quiet  and  recumbent, 
to  lessen  the  demands  on  his  lungs. 

Let  him  rest  in  an  even^  icarm  temperature  (C5°  to  70°  F.), 
in  a  fairly  large  and  well -ventilated  room,  to  lessen  the 
irritable  cough  produced  by  the  inhalation  of  cold  air. 
The  fire  will  act  as  an  efficient  aid  to  ventilation. 

Nourish  him  with  simple  foods  easy  of  digestion,  avoid- 
ing at  first  solids,  such  as  meat  and  fish,  which  might  tax 
unduly  his  digestive  apparatus.  Let  him  have  an  abun- 
dance of  warm  fluids. 


TREATMENT    OF    BRONCHITIS.  465 

.If  tbe  feeling  of  suffocation  or  pain  behind  the  breast- 
bone be  acute,  apply,  at  frequent  intervals,  large,  well- 
macle,  hot  linseed  poultices  to  the  front  and  back  of  the 
chest,  remembering,  however,  that  even  this  simple  meas- 
ure is  to  be  avoided  in  mild  cases,  for  poultices  are  both 
debilitating  and  disagreeable. 

If  further  treatment  be  desirable,  the  following  inhala- 
tion may  be  used  : 

Oil  of  Hops 15  drops. 

Liojht  Carbonate  of  Maixnesium     10  grains. 

Glycerine,  up  to 3  ounces. 

Mix.  One  teaspoonful  of  this  admixture  to  be  added 
to  a  quart  of  hot  water  (about  150°  to  170°  F.)  and  in- 
haled frequently. 

A  mild  purgative  (castor  oil)  may  be  taken  in  this  stage. 

I7i  the  second  stage,  expectoration  will  have  commenced, 

and,  while  rest,  quiet,  warmth,  etc.,  must  still  be  secured, 

neither  poultices  nor  the  above  inhalation  will  often  be 

required. 

Hot  drinks  of  a  mildly  stimulating  character,  such  as 
infusions  of  tea,  coffee,  cocoa,  or  coca,  are  often  grateful 
to  the  patient  and  tend  to  facilitate  expectoration.  If, 
however,  the  latter  remain  scanty,  chloride  of  ammonium 
may  be  inhaled  from  a  special  apparatus  (the  best  I  am 
acquainted  with  is  made  by  Godfrey  &  Cooke,  Chemists, 
of  Conduit  Street,  London,  W.,  Avho  supply  with  it  all  di- 
rections for  use),  or  that  drug,  a  very  harmless  one  in  any 
case  and  a  mild  stimulant,  may  be  used  internally,  thus  : 
Chloride  of  Ammonium  ...  1  drachm. 
Liquid  Extract  of  Liquorice  .     .     4  drachms. 

Simple  Syrup        1  ounce. 

Water,  up  to G  ounces. 

Mix.     One  tablespoonful   in  a  wineglassful   of   water 
every  four  hours. 
20* 


466  DISORDERS    OF    THE    LUNGS. 

Or  three  lozenges  of  chloride  of  ammonium  (containing 
each  2  grains  of  the  drug  in  black-currant  paste)  may  be 
taken  at  the  same  intervals.* 

The  diet  in  this  stage  may  be  more  liberal  than  in  the 
first — no  solids  being,  however,  allowed — and  may  include 
often  a  little  weak,  hot,  spiced  wine  (light  port  or  claret) 
and  water,  or,  in  place  of  the  latter,  half  a  teaspoonful  of 
spirits  of  sal  volatile  in  a  wineglassful  of  water  occasion- 
ally. 

In  the  third  stage,  the  patient  may,  as  a  rule,  be  allowed 
to  sit  up  and  even  move  about  the  room,  while  at  the  same 
time  a  gradual  return  to  a  normal  diet  and  a  fair  allow- 
ance of  a  good  red  Burgundy  or  of  old  port  may  be  per- 
mitted. Little  or  no  physic  will  be  necessary  unless  the 
customary  large  doses  of  ipecacuan,  squills,  etc.,  have  so 
deranged  the  stomach  and  stimulated  the  bronchial  linings 
as  now  to  call  for  an  opiate  as  a  corrective.  If  this  has 
been  the  case,  the  following  formula  will  be  found  both  a 
suitable  and  agreeable  one  for  adults  : 

Of  compound  tincture  of  lavender  and  amraoniated 
tincture  of  opium,  each  ^  oz.;  of  syrup  of  squills,  caraway 
water,  and  glycerine,  each  2  oz.  Mix.  Take  one  table- 
spoonful  three  times  a  day. 

I  repeat  once  more  that,  as  regards  treatment,  the  worst 
cases  of  bronchitis,  those  dependent  upon  some  potent 
mischievous  poison  in  the  blood,  are  better  without  any 
medicine  directed  to  the  condition  of  the  lung,  every  effort 
l)eing  directed  to  the  eviction,  if  possible,  from  the  body 
of  such  impurity,  and  to  the  maintenance  of  the  general 
strength.      In  cases  where  chill  has  been  great,  and  the 

*  It  is  difficult  to  understand  how  any  apparatus  more  mischievous 
than  the  ordinary  "  Bronchitis  kettle  "  could  have  been  devised  by 
man.  It  throws  into  the  sick-room  jets  of  vjipor,  which,  condensing, 
soak  the  clothing,  bedding,  etc. 


THE    NATURE    OF    CAPILLARY   BRONCHITIS.  467 

blood  is,  as  far  as  can  be  judged,  fairly  pure,  the  ordinary 
exj^ectorant  drugs  may  be  used,  but  are  always  better 
avoided,  recovery  being  more  rapid,  and  convalescence 
more  satisfactory,  without  them.  In  the  case  of  children, 
the  most  frequent  sufferers  of  all,  beyond  poulticing,  warm 
air,  and  suitable  diet,  the  less  in  the  way  of  medication 
that  is  attempted,  the  better  for  the  infant. 

(2)  Bronchitis,  affecting  the  smaller  bronchial  tubes,  and 
often  extending  to  the  air-cells  and  real  lung  substance, 
hence  its  two  names.  Capillary  Bronchitis  and  Lobular  Pneu- 
monia. 

This  derangement  in  its  manner  of  onset,  its  course,  its 
prognosis,  and  its  victims,  oifers  a  strong  contrast  to  the 
bronchitis  which  we  have  just  discussed. 

Capillary  Bronchitis,  to  give  it  the  more  usual  name,  at- 
tacks almost  exclusively  the  debilitated,  especially  at  the 
extremes  of  life,  being  a  common  sequence  of  an  attack  of 
measles  in  a  scrofulous  child.  It  may  also  occur  in  youth 
and  middle  life  in  very  delicate  individuals. 

It  is  characterized  by  but  one,  often  a  very  prolonged, 
stage. 

In  a  feeble  aged  person  or  a  child  that  has  never  thriven 
— for  such  form  nine  tenths  of  the  sufferers — a  cough,  dry 
and  frequent,  is  noticed  ;  with  this  there  is  loss  of  ap2?etite 
and  fever,  markedly  loorse  toioards  night,  the  body  at  that 
time  being  often  bathed  in  perspiration ;  there  accom- 
panies these  symptoms  a  rapid  falling  off  in  flesh  and 
strength.  The  breathing  is  quickened,  but  there  is  no  sense 
of  suffocation,  nor  are  there  apparent,  to  the  ordinary  by- 
stander, any  of  those  loud,  snoring,  wheezing  sounds  so 
common  in  ordinary  bronchitis.  The  expectoration  is 
usually  scanty  and  sometitnes  hlood-tlnged. 

In  the  aged,  death  is  almost  a  certain  termination  in  this 
variety  of  bronchitis  ;  in  infancy  recovery  occurs  in  per- 


468  DISORDERS    OF    THE   LUNGS. 

haps  50  per  cent,  of  the  cases,  but  convalesceuce  is  slow  ; 
ill  youth  and  middle  age  recovery  is  more  frequent,  but 
there  is  always  considerable  danger  that  the  disease  may 
pass  into  the  form  of  inflammatory  consumption,  the  part 
of  the  lung  affected  with  the  bronchitis  breaking  down. 
This  variety  of  consumption  may,  however,  be  recovered 
from,  for,  unlike  the  tubercular  form  of  that  disease,  it  is 
for  a  long  time  an  almost  purely  localized  condition. 

The  treatment  of  capillary  bronchitis  consists  in  the 
maintenance  and  preservation  of  the  general  strength. 
Poulticing  is  useless,  and  expectorant  medicines  are  di- 
rectly mischievous.  The  one  risk  is  failure  of  the  strength 
as  shown  by  the  termination  in  consumption  or  in  death 
from  exhaustion.  Rest,  in  a  warm,  well-aired  room,  and 
judicious  feeding,  are  the  measures  that  alone  can  secure 
good  results.  If  the  cough,  by  its  frequency,  interfere 
with  sleep,  soothing  inhalations  are  the  safest  means  to 
allay  it. 

Pneumonia,  or  inflammation  of  the  lungs  {lobular  pneu- 
monia). — This  disease,  which,  in  its  typical  form,  the  one 
which  we  will  first  discuss,  consists  of  three  well-marked 
stages,  exhibits,  in  its  course,  duration,  and  consequences, 
marked  variations,  depending  upon  the  extent  of  the 
malad}^,  the  cause  producing  it,  and  the  strength  of  the 
sufferer. 

First  Stage. — Sudden  shwering  ;  marked  fever ;  nausea; 
flushed  face  (especially  over  cheek  bones)  ;  difficulty  of 
hreatJiing  /  dry,  hard,  short  couyh,  often  accompanied  by 
acute  2^ain  in  \\\c?>\diQ  \  rapid,  full  pulse  ;  drysJcln;  thirst; 
and  great  prostration  of  strength.  During  this  stage  the 
part  of  the  lung  attacked,  always  a  considerable  area,  is 
engorged  with  blood.  This  is,  in  fact,  called  "  the  stage 
of  engorgement.'''' 

Second  Stage. — The  urgent  symptoms  which  marked  the 


THE    SYMPTOMS    OF    PNEUMONIA.  469 

first  stage  become  even  more  pronounced,  and  delirium  is 
frequently  superadded.  Thick,  tenacious,  rusty -looking  ex- 
pectoration, like  prune-juice,  is  often  seen. 

In  this  stage  the  appearance  of  the  lung  closely  resem- 
bles that  of  the  liver.  It  is  therefore  known  as  the  "  stage, 
of  red  hepatization.^'^ 

Third  Stage. — This  is  marked  by  an  amelioration  in  the 
symptoms.  The  breathing  becomes  less  short  and  the  ex- 
pectoration more  easy  and  copious  ^'  the  feverish  condition 
abates. 

The  lung  in  this  stage,  while  still  remaining  solid,  as- 
sumes a  grayish  hue,  and  is  less  firm  and  solid  than  in  the 
last.  This  is  known  in  pathology  as  ^^  the  stage  of  gray 
hepatization.'''' 

Such  is  briefly  the  course  of  an  attack  of  medium  se- 
verity as  seen  in  a  vigorous  person,  and  which  is  much  less 
dangerous  than  the  urgency  of  the  symptoms  would  lead 
the  layman  to  imagine.  Still,  even  in  this  class  of  pneu- 
monia, death  may  occur  in  the  first  two  or  three  days  from 
the  exteyit  of  the  disease,  which  may  involve  both  lungs 
and  thus  render  recovery  impossible  ;  or  later  on,  from 
the  formation  of  a  large  lung  abscess,  or  from  mortifica- 
tion of  a  portion  of  the  lung,  dangers  which  appear  only 
towards  the  end  of  the  third  stage.  The  average  duration 
of  an  attack  of  pneumonia  is  ten  days. 

In  young  children  pneumonia  is  uncommon,  while  in 
vvomen  generally,  and  in  the  very  delicate  and  aged  of 
both  sexes,  though  the  three  stages  of  consolidation  and 
of  red  and  gray  hepatization  are  all  present,  yet  the  external 
symptoms  2uX^nery  different  ivovn  those  which  mark  such  a 
typical  case  as  I  have  described.  The  shortness  of  breath 
in  them  is  rarely  extreme,  the  fever  is  more  moderate,  and 
the  disease  is,  in  appearance,  less  formidable.  In  reality 
the  opposite  is  the  case,  the  disorder  is  more  apt  to  end 


470  DISORDERS    OF    THE    LUNGS. 

fatally,  or,  if  recovery  does  occur,  the  acute  stages  of  the 
disorder  are  prolonged  of  ten  for  three  or  four  weeks,  while 
not  very  unfrequently  the  recovery  is  only  partial,  and  con- 
sumption is  left  behind. 

According  to  the  best  authorities,  of  fairly  healthy  men 
from  fifteen  to  fifty  years  of  age  five  sixths  recover  ;  of 
women  of  the  same  age,  three  fourths  ;  of  persons  over 
fifty  years  of  age  and  of  both  sexes,  about  one  half  ; 
of  the  class  we  are  now  to  discuss,  not  more  than  one 
fourth. 

When  the  blood-stream  is  much  polluted,  as  in  Bright's 
disease,  in  diabetes,  in  drunkards,  and  in  those  stricken  by 
malignant  fevers,  pneumonia  may  be  set  up  by  the  smallest 
provocation,  and  constitutes  then,  as  indeed  one  might  ex- 
pect, a  very  dangerous  complication. 

Treatment. — At  first  sight  no  disease  would  seem  more 
urgently  to  demand  treatment  than  pneumonia.  Yet  it 
must  be,  and  in  fact  is,  conceded,  since  the  experiments 
made  by  Professor  Hughes  Bennett  conclusively  demon- 
strated the  fact,  that  non-medication  is  more  happy  in  its 
death-rate  and  general  results  than  any  system  of  drug 
treatment. 

As  in  bronchitis,  and  in  all  acute  lung  affections,  the 
patient  mxLSt  economize  his  breathing  powers  by  absolute 
rest  of  mind  and  body,  and  must  endeavor  to  soothe  the 
irritated  bronchial  linings  and  favor  the  action  of  the  skin 
by  warm  air.  A  purge  may  also  be  administered,  and 
light  fluids  and  easily  digested  foods  should — sparingly 
in  proportion  as  the  fever  is  high — be  administered.  In 
the  delicate  and  weakly,  in  whom  the  fever  does  not  run 
so  high,  a  more  stimulating  regime,  including  a  fair  pro- 
portion of  sound  wine,  is  to  be  commended.  Poultices  arc 
absolutely  powerless  to  mitigate  the  severity  of  the  attack, 
but  may  be  applied  to  mitigate  severe  pain. 


PNEUMONIA    AND    TLEUEISY.  471 

Carbonate  of  ammoniiira,  in  the  form  of  20  drops  of  spirit 
of  sal  volatile,  may  be  administered  every  three  hours  in 
a  wineglassful  of  camplior  water,  and,  in  adults,  10  grains 
of  Dover's  powder  may  be  given  in  gruel  each  niglit,  the 
first  to  stimulate  mildly  the  patient,  the  second  to  secure 
some  rest  to  the  nervous  system,  in  sleep.  Both  drugs  are, 
however,  but  in  exceptional  cases,  best  avoided. 

Pneumonia  sometimes  prevails  as  an  epidemic,  and  seems 
in  such  cases  to  be  slightly  contagious. 

Pleurisy  is  the  name  given  to  a  more  or  less  extended 
inflammation  of  the  lymph  spaces,  the  pleural  cavities, 
which  surround  the  lungs. 

It  is  caused,  like  pneumonia,  by  an  unhealthy  state  of 
the  blood,  and  especially  of  the  lymphatic  system,  of  which 
the  pleura  is  an  organ,  though  the  attack  is  usually  pre- 
cipitated, finally  determined,  by  a  chill,  arresting,  in  a 
greater  or  less  area,  the  action  of  the  skin. 

It  is  a  common  accompaniment  of  pneumonia,  the  in- 
flammatory process  in  the  lung  extending  to  the  contiguous 
parts  of  the  pleurae,  and  is  the  cause  of  the  pain  which  is 
so  often  felt  in  the  former  disease.  An  attack  of  ordinary 
severity  is  characterized  by  three  distinct  stages. 

First  stage,  marked  by  sliiveriyig,  fever,  and  sharp  pain 
in  the  side  (but  sometimes  referred  to  the  abdomen)  which 
renders  deep  breathing  impossible.  The  pulse  is  raised,  but 
is  not  so  fast  nor  so  full  as  in  typical  pneumonia,  nor  is 
there  any  marked  flush  on  the  cheek  bones,  nor  any  urgent 
sense  of  suffocation.  There  is  a  dry,  frequent  cough.  This 
stage  marks  a  congestion  and  swelling  of  the  surfaces  of 
the  pleurje  and  a  slight  gumming  together  of  these. 

Second  stage. — The  fever  is  higher,  the  pulse  more  raised, 
and  the  breathing  7nore  shallow,  but  less  painful.  The 
cough  continues,  and  the  patient  finds  it  impossible  to  rest 
on  the  sound  side  on  account  of  the  weight  of  fluid  poured 


472  DISORDERS    OF   THE    LUNGS. 

out  on  the  affected  side,  which  is  often  bulged  out  and 
motionless,  or  nearly  so,  when  a  breath  is  taken. 

This  is  called  the  "  stage  of  effusion,''''  because  fluid, 
usually  thin  and  serous,  but  sometimes,  in  severe  cases, 
bloody  or  purulent,  is  poured  out  into  the  pleural  cavity, 
*  displacing,  by  floating  upwards,  the  lung  and  sometimes 
also  the  heart,  and  rendering  the  lung  thus  squeezed  al- 
most useless. 

Tldrd  stage,  usually  in  its  symptoms  like  the  first  one. 
The  effused  fluid  is  slowly  reabsorbed  by  the  pleural  sur- 
faces, the  lung  fills  again  with  air,  and  the  stitch-pain, 
more  or  less  absent  in  the  second  stage,  because  the  effu- 
sion kept  the  inflamed  surfaces  apart,  reappears  for  a  time, 
gradually  passing  away. 

The  duration  of  the  attack  is  uncertain  ;  it  rarely  lasts 
less  than  three  weeks,  and  assumes  in  all  individuals  at- 
tacked a  very  similar  aspect. 

Pleurisy  varies  much  in  severity.  It  is,  as  shown  by 
tlie  post-mortem  examination  of  those  who  have  never 
complained  of  pleurisy,  but  who  bear  marked  traces  of  its 
I'avages,  an  exceedingly  common  complaint,  not  un  fre- 
quently painless,  and  productive  of  few  phenomena.  Its 
danger  is  to  be  gauged  by  the  extent  of  pleura  affected 
and  by  the  nature  and  rapidity  of  the  disappearance  of 
the  effused  fluid.  If  both  pleurse  be  affected,  there  may 
ensue,  unless  prompt  measures  be  taken,  suffocation  from 
the  grave  interference  with  the  lung  functions,  while  if, 
as  is  frequent  in  the  unhealthy,  and  especially  in  the 
scrofulous,  the  effusion  be  purulent,  death  may  result  from 
exhaustion  or  from  perforation  of  the  lung  by  the  matter. 

Pleurisy  is  an  exceedingly  common  complication  in 
Bright's  disease  and  in  impure  states  of  the  blood  gen- 
erally. 

Its  treatment  is  far  more  satisfactory  than  that  of  pneu- 


THE  TKEATMEXT  OF  PLEUEIST.  473 

monia,  inasmuch  as  it  is,  when  most  necessary  and  of  most 
avail,  sm-gical  in  its  nature. 

Rest  of  mind  and  body  are  in  pleurisy,  as  in  all  acute 
disorders,  the  first  desiderata.  The  air  of  the  bedroom 
should  be  warm  (60°  to  65°  F.),  but  need  not  exceed  the 
latter  figure  unless  pneumonia  or  bronchitis  be  also  pres- 
ent. Simple,  light,  and  nourishing  food  may  be  given  in 
fair  amount,  but  no  stimulant  will  be,  at  any  rate  in  the 
first  stage,  called  for.  It  is  well  to  see  that  the  bowels 
are  kept  regular,  and,  indeed,  if  the  patient  be  robust,  a 
purge  may  be  given  every  day  for  the  first  few  days. 

Directly  the  pleurisy  declares  itself  an  effort  should  be 
made,  by  exciting  an  inflammation  of  the  skin  over  the 
seat  of  disorder,  to  moderate  the  deeper  inflammatory  pro- 
cesses. For  this  purpose  a  mustard  plaster,  or,  better  still, 
free  painting  with  blistering  collodion  will  best  avail. 
Directly  this  object  has  been  attained,  the  irritated  skin 
may  be  covered  with  vaseline  and  cotton-wool,  and  a  firm 
pair  of  boneless  stays,  whatever  the  sex  of  the  sufferer, 
should  be  applied.  Tight-lacing  is,  in  this  one  exceptional 
instance,  not  only  permissible  but  advantageous,  for  it 
limits  the  movement  of  the  lower  part  of  the  lungs  —  by 
far  the  most  common  seat  of  pleurisy — and  thereby  not 
only  secures  to  the  inflamed  pleurae  rest,  but  serves  also 
to  considerably  mitigate  the  pain. 

As  soon  as  the  second  stage,  that  of  effusion,  has  set  in, 
the  one  tiling  necessary  is  to  note  carefully  the  amount  of 
the  fluid — though  none  but  the  doctor  can  be  trusted  to 
ascertain  this — and  if  it  increases  so  as  to  compress  seri- 
ously the  lung  or,  as  in  some  cases,  both  lungs,  or  if  it  dis- 
places very  considerably  the  heart,  the  chest  must,  with- 
out delay,  be  tapped.  The  operation  is  almost  painless, 
and  is  speedily  followed  by  immense  relief.  Many  lives 
are  lost  by  neglect  of  this  simple  measure.     Again,  in  the 


474  DISOEDERS    OF    THE    LUNGS. 

cases  whore  the  effusion  is  but  moderate,  tapping  must  be 
resorted  to,  if,  at  tlie  end  of  ten  days  at  the  latest,  the 
water  does  not  diminish,  for  a  king  too  long  compressed, 
even  if  the  compression  be  not  extreme,  will  never  com- 
pletely regain  expansile  power  ;  and,  moreover,  a  fluid,  such 
as  that  exuded  in  pleurisy,  will  not  always  long  remain 
without  undergoing  change,  and  when  once  pus  is  formed 
and  what  is  called  Empyaema  is  present,  the  chances  of 
ultimate  recovery  are  much  reduced,  and  a  more  formi- 
dable oipersLtion  than  mere  tai:)ping,  namely,  free  opening 
and  drainage  of  the  pleural  cavity,  becomes  necessary. 

If,  as  may  happen,  after  all  feverish  symptoms  have  dis- 
appeared, a  very  small  quantity  of  effused  fluid  remains, 
chansre  of  air  to  a  mild  climate  and  outdoor  exercise  are 
the  means  to  be  adopted  for  its  removal. 

The  Degenerations  of  the  Lungs. 

Phthisis,  or  Consumption  of  the  Lungs. — I  have  already 
been  drawn  into  the  discussion  of  this  disease,  but  must 
again  remind  my  readers  that  under  this  one  term  are  in- 
cluded really  totally  different  complaints.  First  and  worst 
of  all,  we  have  Tubercular  Phthisis,  or  Galloping  Consump- 
tion, really  a  general  disease,  most  prominent  usually  in 
its  lung  symptoms.  In  this  variety  there  is  really  no  hope 
of  recover}^,  for  the  lung  is  attacked,  as  is  the  body  in 
general,  from  ten  thousand  sides,  and  death  will  often 
supervene  ere  yet  there  be  apparent,  by  auscultation  of  the 
lung,  any  absolutely  certain  signs  of  the  presence  of  phthisis. 
Great  and  rapid  icasting  and  loss  of  strength,  with  com- 
plete absence  of  ajypetite,  and  an  inability  to  assimilate  the 
lightest  foods,  mark  the  disorder,  which  often  ends  fatally 
in  six  weeks.  Then  we  have  Inflammatory  Phthisis,  at  first 
but  a  local  disorder  due  to  pneumonia,  or  to  capillary  bron- 
chitis of  such  severity  as  to  lead  to  a  localized  destruction 


THE    DIFFERENT    KINDS    OF    CONSUMPTION.  4/0 

of  lung  tissue.  In  inflammatory  consumption,  unless  the 
neighboring  blood-vessels  and  lymphatics  absorb  some  of 
the  broken-down  material,  and  thus  infect  distant  parts  of 
the  body,  of  which  there  is  always  danger,  great  hopes  of 
ultimate  recovery  may  be  entertained.  In  these  cases,  as 
in  all  chronic  inflammatory  mischief  of  every  kiiul,  attended 
by  breaking  dovm  of  tissues,  we  shall  have  chronic  fever, 
worse  at  night,  and  often  marked  by  profuse  sweating  ;  and 
we  shall  also  witness  debility,  loss  of  flesh,  absence  of  appe- 
tite, and  a  great  lessening  of  assimilative  pov^er.  Of  course 
we  shall  also  have  cough,  and  probably  some  expectoration 
of  blood.  The  symptoms  here,  w^hich  are  identical  with 
those  of  slow  necrosis  of  deep-seated  bones,  and  with  those 
of  severe  chronic  abscess,  need  not  excite  grave  alarm, 
provided  the  patient's  strength  is  good  and  means  are  at 
hand  to  assist  in  its  maintenance.  Scores  of  cases  of  this 
order  I  have  seen,  when  much  emaciated,  completely  re- 
cover. A  few  modern  surgeons  have  boldly,  but  very 
rationally,  suggested  that  this  variety  of  consumption 
should  be  treated  on  the  lines  of  deep  abscess,  the  diseased 
part  being  exposed  and  thoroughly  cleansed  ;  and  indeed 
the  only  objection  to  be  raised  to  this  course  is  that  so 
many  cases  get  well  w^ithout  the  adoption  of  any  active 
interference,  medical  or  surgical.  Waiting,  however,  in- 
volves every  day  a  risk  that  the  system  at  large  may  be- 
come poisoned  by  the  broken-down,  bacilli-loaded  tissues 
of  the  cavity. 

Inflammatory  Phthisis,  even  w^hen  fatal,  may  not  kill  its 
victim  for  many  years. 

The  third  variety  of  consumption  is  called  Fibroid  Phthi- 
sis, but  is  a  totally  different  process  from  either  of  the  last. 
It  is  a  fibrosis  of  the  lung,  a  swelling  followed  by  a  con- 
traction of  the  fibrous  binding  material  and  a  consequent 
slow  strangulation  of  tissues.  It  is  a  rare  disease,  quite 
incurable,  and  may  last  for  very  many  years. 


476  DISORDERS    OF    THE   LUNGS. 

Treatment  of  Consumption. — Of  this  little  need  be  said. 
Xone  is  of  the  least  avail  in  the  tubercular  form.  In  the 
inflammatory  variety,  the  maintenance  of  the  general 
strength  and  nutrition  of  the  body  are  the  great  objects 
to  be  held  in  view  ;  a  sea  voyage  is  often  an  excellent 
measure  in  the  early  stages,  or  a  prolonged  visit  to  an 
elevated  region.  Many  cases  get  well  under  any  or  no 
treatment,  and  it  is  this  variety  that  the  quack  consump- 
tion curer  claims  to  save  from  death,  and  that  he  may, 
like  any  other  man,  easily  cure,  when  he  treats  consump- 
tion at  all ;  for  the  vast  majority  of  his  cases  are  not 
examples  of  this  disease,  but  instances  of  simple  anoemia, 
of  chlorosis,  of  capillary  bronchitis,  etc. 

For  fibroid  phthisis  there  is  no  special  treatment  that 
avails  aught. 

Of  the  other  degenerative  changes  that  may  take  place 
in  the  breathing  apparatus,  such  as  Cancer  of  the  Lung,  Morti- 
fication of  the  Lung,  or  Simple  Abscess  of  the  Lung,  I  shall 
not  speak.  They  are  all  of  them  exceedingly  rare  dis- 
eases, to  be  diagnosed  and  treated  only  by  a  skilled  phy- 
sician. 

Other  Transient  or  Permanent  Diseased  Conditions  of  the 

Lungs. 

Asthma  is  a  nervous  affection  of  the  lungs,  productive 
of  spasmodic  contractions  of  the  bronchial  tubes  or  con- 
gestion of  their  mucous  linings. 

It  is  characterized  by  the  sudden  advent,  without  fever, 
and  often  with  a  subnormal  temperature,  oiloud loheezings 
and  ichistlings  in  the  chest,  accompanied  by  great  diffi- 
culty of  breathinrj  /  the  sufferer  being  often  unable  to  lie 
down  and  having  a  marked  sense  of  impending  suffocation, 
the  face  becoming  congested,  the  Upjs  purple,  and  the  eyes 
often  staring  and  bloodshot. 


THE    CAUSES    OF    ASTHMA.  411 

It  is  chiefly  caused  by  irritation  of  the  motor  nerves 
which  go  to  the  circular  muscular  fibres  of  the  bronchial 
tubes. 

This  irritation  may  be  direct  and  the  result  of  the  in- 
breathing, in  persons  of  specially  sensitive  nervous  ap- 
paratus, of  irritating  substances.  The  pollen  of  certain 
flowering  grasses  will  thus  produce  hay-asthma  in  some  ; 
in  others,  the  fine  dust  in  the  air  of  a  recently  swept  room, 
the  smoke  of  a  candle  recently  blown  out,  the  emanations 
given  off  in  a  close  stable,  even  the  proximity  of  a  fur 
rug,  and  a  host  of  other  apparently  trivial  causes  may, 
in  the  specially  predisposed,  set  the  spasm  of  asthma  in 
motion. 

Most  often  the  exciting  cause  is  an  indirect,  a  so-called 
reflex  (reflected),  one ;  thus  a  distant  organ  is  the  seat  of 
some  irritation,  and  is  therefore  constantly  transmitting  to 
the  brain,  by  means  of  its  afferent  nerves,  currents  which 
in  people  of  normal  nervous  system  are  reproduced  as  mo- 
tor nerve  force,  travelling  back  only  to  the  affected  organ 
to  set  up  therein  some  action  whose  direct  effect  it  will  be 
to  assist  recovery  by  expelling  the  cause  of  the  disorder. 
But  in  people  who  have  inherited,  or  have  acquired,  an 
over-sensitive  nerve-tissue,  the  impression  brought  to  the 
brain  by  the  nerves  from  the  irritated  organ  will  often 
spread  from  the  one  nerve-centre  to  which  it  goes  to  con- 
tiguous ones,  and  as  a  result  motor  currents  will  be  sent 
down  to  other  organs.  Thus  epilepsy  may  be  the  result 
of  the  presence  of  tape- worm  in  the  bowel,  and  violent 
hysterical  convulsions,  or  the  rigid  muscular  contractions 
known  as  catalepsy,  may  depend  upon  an  inflamed  or  con- 
gested ovary  or  womb.  Most  often,  however,  the  brain 
centre  of  the  pneumogastric  nerve,  the  motor  nerve  of  the 
luno-,  is  affected  by  this  disseminated  impression  brought 
bv  an  afferent  nerve,  and  the  result  we  witness  in  asthma. 


478  DISORDERS    OF    THE    LUXGS. 

The  commonest  seat,  then,  of  the  real  cause  of  an  asth- 
matic seizure  may  often  be  found  in  some  organ  in  no  way 
connected  with  the  functions  of  respiration  ;  the  stomach 
is,  of  all  organs,  most  commonly  thus  at  fault,  next  in  fre- 
quency as  a  cause  stand  the  icornb  and  ovaries,  and  next 
comes  the  intestine.  In  children,  how^ever,  the  teeth  are 
by  far  the  most  frequent  seat  of  irritation,  nine  tenths  of 
the  so-called  Teething  Bronchitis  of  children  being  nothing 
but  asthma. 

Asthma  results  nearly  always  in  recovery  as  far  as  the 
attack  is  concerned,  but  oft-repeated  seizures  lead  at  last 
to  that  chronic  dilatation  of  the  small  air-vesicles  of  the 
lung  w^iich  is  known  as  Pulmonary  Emphysema,  while  the 
strain  thrown  on  the  heart  in  its  efforts  to  pump  the  blood 
through  the  lungs  during  the  attacks  ends  in  many  cases 
at  last  in  stretching — i.  e.,  dilatation — of  the  right  side  of 
that  organ,  and  thus  to  enfeebled  cardiac  action,  and  event- 
ually to  a  fatal  issue. 

Remarks. — Asthma  is  in  reality  a  disorder  of  the  ner- 
vous system,  closely  allied  in  nature  to  epilepsy,  to  hys- 
teria, to  catalepsy,  and  to  spastic  rigidity,  and  is  only  for 
the  sake  of  convenience  placed  here  among  the  lung  affec- 
tions. When  asthma  is  seen,  therefore,  in  a  member  of  a 
neurotic  family,  the  outlook  is  grave  in  proj^ortion  as  the 
neurotic  inheritance  is  great.  As  we  might  expect,  gout 
poison  in  the  blood  verj'-  often,  by  producing  acidity  of 
the  stomach,  tends  to  the  production  of  asthma.  In  the 
elderly  or  broken-down,  asthma,  however,  is  often  seen  as 
a  mere  sign  of  debility  of  the  nervous  system,  and  then 
attacks  the  patient  in  the  early  morning  (2  to  6  a.  m.), 
when  the  lowest  point  of  nervous  force  in  the  twenty-four 
hours  is  reached.  A  little  stimulant  —  e.  </.,  coffee,  tea, 
coca,  spirit  of  sal  volatile,  guarana,  alcohol,  or  beef-tea, 
etc. — will  often  arrest  these  early-morning  attacks,  though 


TREATMENT    OF    ASTHMA.  479 

the  sufferer  will  do  well,  by  way  of  precaution,  to  keep 
the  air  of  his  bedroom  warm  during  the  night  by  means  of 
a  fire,  and  to  avoid  new  blankets  and  feather  beds. 

In  the  first  attacks  of  asthma  suffocation  is  often 
dreaded.  It  cannot,  ho^v^ever,  owing  to  a  A'ery  simple 
reason,  occur,  for,  as  the  respiration  becomes  more  and 
more  impeded,  carbonic  acid  collects  more  and  more  in 
the  blood,  until  at  last,  by  its  anti-spasmodic  action  it  ar- 
rests the  spasm.  In  asthma  we  have,  then,  one  of  the 
clearest  and  most  undeniable  of  examples  of  the  beneficial 
action  of  an  apparently  totally  mischievous  symptom. 

Treatment  of  Asthma. 

(a)  Of  the  Asthmatic  Seizure. — The  cause  is  to  be  sought 
and  got  rid  of.  If  this  be  found  in  a  direct  irritant,  such 
as  dust,  the  patient  must  of  course  avoid  a  dust-laden  at- 
mosphere, or  wear  some  simple  inhaler,  a  woollen  muffler 
will  usually  suflice,  over  the  mouth  and  nose  while  exposed 
to  it.  If  stomach  disorder  be  present,  or  intestinal  irrita- 
tion be  a  suspected  cause,  a  smart  alkaline  purge,  such  as 
the  following,  is  a  necessary  measure  : 

Take  of  castor  oil,  |^  ounce;  of  bicarbonate  of  sodium, 
20  grains  ;  of  peppermint  water,  2  ounces.  Mix,  shake 
well,  and  take  at  once.  Or,  in  place  thereof,  a  full  dose 
of  Gregory's  powder,  which  may,  if  necessary,  be  repeated 
daily.  If  the  womb  or  ovaries  be  at  fault,  means  suited 
to  their  restoration  to  health  must  be  adopted,  while,  for 
present  succor,  a  purgative  draught,  such  as  that  just  men- 
tioned, followed  by  10-gTain  doses  of  bromide  of  potassium 
in  a  little  syrup,  every  two  hours,  till  eight  or  ten  doses 
have  been  taken,  will  generally  suffice. 

Of  empirical  remedies  and  combinations,  the  following 
are  very  eificacious,  in  adults  : 


480  DISORDERS    OF    THE    LUNGS. 

Nitrite  of  Amy] 6  drojos. 

Spirits  of  Ether 4-  ounce. 

Compound  Tincture  of  Lavender  ,     ^  ounce. 
Spirits  of  Cliloroforni      ....     1  ounce. 
Mix.     A  small  teaspoonful  in  water  every  hour  till  the 
asthmatic  spasm  improves. 

Iodide  of  Potassium 2  drachms. 

Carbonate  of  Ammonium    ...     1  drachm. 

Camphor  Water 3  ounces. 

Mix.  One  teaspoonful  in  plain  or  peppermint  water 
every  two  or  three  hours  during  the  attack.  To  be  con- 
tinued thrice  daily,  for  a  few  days,  even  after  the  disajD- 
pearance  of  the  asthma. 

The  last-named  mixture,  while  singularly  efficacious  in  all 

forms  of  asthma,  even  in  hay-asthma,  is  practically  harmless. 

When  asthma  is  complicated  with  bronchitis  (bronchitic 

asthma),  the  following  is  an  excellent  formula  for  giving 

relief : 

Carbonate  of  Ammonium     ...     1  drachm. 

Spirits  of  Ether 2  drachms. 

Spirits  of  Chloroform      ....     2  drachms. 

Tincture  of  Lobelia 2  drachms. 

Glycerine 1  ounce. 

Compound  Infusion  of  Orange  Peel,  up  to  6  ounces. 
Mix.     Take  a  tablespoonful  in  water  three  or  four  times 
a  day. 

In  cases  of  chronic  asthma  with  debility,  the  following 
answers  well : 

Iodide  of  Potassium 3  drachms. 

Spirits  of  Sal  Volatile     ....     1  ounce. 
Tincture  of  Belladonna  ....     14^  drachm. 
Compound  Tincture  of  Cinchona  .     2  ounces. 

Caraway  Water 1  ounce. 

Mix.     A  dessert-spoonful  in  water  thrice  daily. 


TREATMENT    OF    ASTHMA.  481 

Inhalations  are  of  great  use.  De  Joy's  cigarettes  are 
well  known;  the  smoking  (and  inhalation  of  the  smoke) 
of  dried  stramonium  leaves  with  a  little  light,  dry  Turkish 
tobacco,  in  a  new  clay  pipe,  is  sometimes  efficacious;  the 
inhalation  of  the  smoke  of  nitre  paper  (made  by  first  steep- 
ing in  a  mixture  of  four  ounces  of  nitre  and  a  pint  of  wa- 
ter, a  sheet  of  red  blotting-paper,  then  drying,  and  finally 
burning  it  under  a  large  cone  of  stiff  paper,  to  the  apex 
of  which  the  patient  applies  the  mouth),  or  of  ozone  paper, 
or  of  various  herbal  mixtures,  or  of  pastilles  containing 
stramonium  leaves  and  seeds. 

Superior  to  all  of  these  for  adults  I  have  found  the  fol- 
lowing : 

Nitrite  of  Amyl 16  drops. 

Chloroform 2  drachms. 

Absolute  Alcohol,  to 1  ounce. 

Mix.  One  teaspoonful  to  be  sprinkled  on  cotton-wool, 
and  inhaled  when  the  asthmatic  spasm  is  very  severe. 

I  have  dealt  somewhat  at  length,  and  in  opposition  to 
my  own  opinion,  on  the  medicinal  treatment  of  the  asth- 
matic spasm,  and  that  because  the  complaint  is  a  frequent 
one,  for  the  relief  of  the  distress  arising  from  which  most 
people  are  willing  to  face  the  after  consequences  and  side 
consequences  of  drugs  that  will  temporarily  afford  relief, 
and  the  use  of  which,  in  any  case,  need  not  be  continued 
for  long. 

For  my  own  part,  I  am  convinced  that  in  spasmodic 
asthma,  forced  inspiration  and  forced  expiration  are  the 
best  and  certainly  the  most  rational  of  measures  for  relief, 
though  the  method  requires  for  success  perseverance  and 
fortitude.  It  is  thus  carried  out :  The  patient  breathes 
out  all  the  air  he  can,  and  then  closes  firmly,  and  for  as 
long  as  he  2^ossihly  can,  his  mouth  and  nose,  remembering 
that  he  cannot  possibly  suffocate  himself  thus.  Then  he 
21 


482  DISORDERS    OF   THE    LUNGS. 

breathes  hi  as  much  air  as  his  kings  will  hold,  and  again 
makes  a  determined  effort  to  retain  it  for  as  long  as  pos- 
sible. Then  he  expels  it,  and  waits,  without  breathing,  for 
as  long  as  possible.  If  he  repeat  these  three  operations 
in  this  sequence — and  they  will  gradually  become  easier 
of  performance — in  a  quarter  of  an  hour  the  asthma  will 
generally  have  departed. 

{h)  Of  the  Asthmatic  Tendency. 

This  consists  in  avoiding  what  is  in  each  individual  tlie 
special  predisposing  cause.  If  gout  be  suspected,  use  the 
remedies  for  gout ;  if  stomach  derangement,  keep  the 
stomach  in  good  order;  if  intestinal  irritation,  watch  care- 
fully over  the  effects  of  special  articles  of  food  and  guard 
against  constipation,  and  so  on. 

Bronchiectasis. — A  dilatation  of  some  one  or  more  of 
the  bronchial  tubes. 

Caused  by  any  prolonged  strain  on  these  structures,  as 
by  whooping-cough  or  chronic  bronchitis;  or  by  wasting 
of  their  walls. 

Characterized  by  more  or  less  embarrassment  of  breath- 
ing, cough,  and  loss  of  general  health,  proportionate  to  the 
extent  of  the  disorder,  and  often  by  great  fcetor  of  the 
breath,  the  result  of  decomposing  mucus  lying  in  the  dilated 
bronchial  tubes. 

llesxdting  in  the  young  and  strong,  if  the  dilatation  be  not 
great  or  extensive,  in  more  or  less  complete  recovery  ;  in 
the  aged  and  broken-down,  contributing  to  a  fatal  issue. 

Treatment. — Deodorizing  inhalations  and  improvement 
of  general  health. 

Collapse  of  Lung. — A  condition  which  may  be  the  result 
of  pressure  by  a  pleuritic  effusion,  of  the  blocking  of  a 
bronchial  tube  by  inflammatory  processes  or  by  mucus,  or 
of  any  growth  (cancer,  aneurism,  etc.)  within  the  chest. 


CONGESTION    OF    THE    LUNGS.  483 

Congestion  of  the  Lungs. — A  temporary  or  permanent 
condition  of  the  lungs,  consisting  in  their  engorgement  to 
a  greater  or  less  extent,  and  for  a  short  or  a  long  time, 
with  blood. 

Temporary  Acute  Congestion  of  the  Lungs  may  mean  one 
of  the  following  things  : 

The  commencement  of  pneumonia,  or  of  caj)illary  bron- 
chitis. 

The  result  of  a  sudden  chilling  of  the  skin. 

Derangement  of  the  heart's  action,  when  it  occurs  as  a 
complication  in  the  course  of  other  disorders. 

Chronic  Congestion  of  the  Lungs  means  nearly  always 
something  permanently  at  fault  in  the  left  side  of  the  heart, 
some  obstruction  to  the  outflow  of  blood  from  the  lungs 
into  the  left  ventricle. 

Chronic  congestion  may,  especially  if  aggravated,  result 
in  oedema  or  dropsy  of  the  lung  tissues.  If  it  persists,  a 
brown  discoloration  and  hardening  of  the  lung  substance 
gradually  takes  place. 

The  syynptoms  of  congestion,  whether  acute  or  chronic, 
are  as  follows  :  Shoi^tness  of  breath,  especially  on  exertion^ 
troublesome  cough,  which  may  be  dry,  frothy,  or  bloody, 
according  to  the  extent  of  the  congestion  ;  turgidity  of 
the  face,  blueness  of  the  lips,  etc. 

There  is  little  or  no  feverishness,  a  distinguishing  feat- 
ure separating  congestion  at  once  sharply  from  all  inflam- 
matory disorders. 

Haemoptysis  {spitting  of  blood)  consists  in  a  discharge  of 
blood  from  the  breathing  apparatus.  It  is  therefore  only 
to  be  viewed  as  a  symptom. 

It  may  be  a  sign  of  the  existence  of  any  one  of  the 
following  : 


484  DISORDERS    OF    THE    LUNGS. 

Congestion  of  the  lung. 

Inflammation  of  the  lung. 

Consumption. 

Aneurism. 

Rupture  of  lung. 

Congestion  or  inflammation  of  the  throat  or  larynx. 

Bronchitis. 

Arrested  hemorrhage  in  other  parts  of  the  body. 
Blood-spitting  is  not  by  any  means  the  formidable  symp- 
tom it  is  often  thought  to  be.  In  only  about  one  third  of 
the  total  cases  does  it  mean  consumption,  and  in  the  vast 
majority  of  all  others  it  is  indicative  only  of  a  temporary 
congestion  of  the  throat,  larynx,  or  bronchial  lining  mem- 
branes. 

The  treatment  will  depend  upon  the  cause. 

Disorders  of  the  Throat  and  Larynx. 

Disorders  of  the  Throat. — Just  a  word  first  on  the  struc- 
ture, functions,  and  derangements  of  the  tonsils.  The  ton- 
sils are,  in  their  main  function,  lymphatic  glands,  and 
therefore,  as  one  might  expect,  often  in  a  chronic  state  of 
swelling  in  scrofulous  subjects.  This  variety  of  enlarged 
tonsils,  which  is  first  noticed  often  as  early  as  the  third 
year  of  life,  forms  one  of  the  greatest  troubles  of  scrofu- 
lous childhood,  their  swelled  and  unhealthy  condition  lead- 
ing to  frequent  and  severe  sore  throat,  while  their  size  and 
the  irritation  they  set  up  interfere  with  sleep,  producing 
loud  snoring,  and  with  the  voice,  which  is  rendered  nasal 
in  character.  A  blocking  of  the  orifice  of  the  Eustachian 
tubes  often  follows  from  this  condition,  and  hence  tem- 
porary attacks  of  deafness. 

The  only  satisfactory  treatment  is  to  remove  a  small 
portion  of  the  surface  of  each  tonsil,  and  to  treat  the 
scrofulous  taint  on  general  grounds. 


DERANGEMENTS  OF  THE  THROAT.  485 

Scrofulous  tonsils  usually  decrease  in  size  after  fifteen 
years  of  age. 

The  other  great  affection  of  the  lymphatic  system,  rheu- 
matism, does  not  often  spare  the  tonsils.  The  swelling  in 
these  cases  is,  however,  generally  intermittent,  and  rarely 
troublesome  in  childhood  and  youth.  This  form  of  en- 
larged tonsil  is  not  benefited  by  operation  ;  each  attack  of 
swelling  should  be  treated  on  the  lines  of  rheumatism. 

There  is  yet  a  third  variety  of  swelled  tonsil,  which 
gives  rise  to  the  disease  known  as  Quinsy.  I  need  scarcely 
inform  the  intelligent  reader  that  an  attack  of  this  com- 
plaint shows  always  a  pre-existing  state  of  ill-health,  and 
as  he  sees  the  tonsils  "  gathering  "  in  the  throat,  the  patient 
may  feel  thankful  that  glandular  suppuration  is  taking 
place  there,  and  not  in  the  lung  or  in  other  deep,  important 
structure.  Quinsy  is  undoubtedly  painful,  but  it  is  not 
dangerous,  and  its  effects  are  as  beneficial  to  the  sufferer 
as  an  attack  of  acute  gout  is  to  the  gouty  man.  It  clears 
the  atmosphere.  Finally,  all  general  disorders  that  fall 
hard  on  the  lymphatic  system  naturally  induce  a  swelling 
of  the  tonsils,  and  thus  in  syj^hilis  and  in  scarlet  fever  it 
is  exceedingly  rare  to  find  these  structures  spared. 

The  condition  of  the  muscles  and  other  tissues  of  the 
throat  next  demands  a  brief  notice. 

The  relaxed  throat,  when  the  relaxation  is  in  the  throat 
and  not,  as  is  often  the  case,  in  the  larynx  and  vocal  chords, 
is  merely  an  indication  of  a  generally  weak  state  of  the 
whole  body,  and  demands  treatment  as  such.  Unfortu- 
nately, there  are  many  '^  lame  ducks,''  whose  structure  is 
so  defective  that  no  measures  avail  to  restore  for  long 
their  general  health,  and  such  as  these  must  spare  the 
throat  as  much  as  possible  if  they  would  avoid  relaxation, 
from  overstrain,  of  that  part.  The  inflamed  throat,  when 
the  inflammation  is  not  centred  in  the  tonsils,  means  con- 


486  DISORDERS    OF    THE    LUNGS. 

gestion  of  the  throat  muscles,  the  result  of  a  chill,  or,  very 
frequently,  gastric  disorder  ;  while  the  chronic  inflamed 
or  congested  throat  means  nearly  always  chronic  gastric  ca- 
tarrh, in  the  majority  of  cases  the  result  of  alcoholic  excess. 

Finally,  we  have  a  superficial  acute  congestion  of  the 
mucous  membrane  of  the  throat,  extending  from  the  nose, 
and  sometimes  also  affecting  the  eyes,  causing  them  to 
water,  and  which  is  known  as  Coryza,  or  Cold  in  the  Head. 
The  cause  is  to  be  found  sometimes  in  a  chilling  of  the 
skin,  sometimes  in  irritating  particles  floating  in  the  air, 
and  affecting  those  whose  mucous  membranes  are  especially 
sensitive.  While,  of  course,  during  its  continuance  espe- 
cial  care  in  respect  to  great  exposure  should  be  taken,  it 
is  a  mistake  to  treat  this  derangement  with  potent  medi- 
cines, such  as  large  doses  of  camphor.  If  any  drug  be 
commendable,  it  is,  but  in  the  case  of  adults  only,  a  single 
10-grain  dose  of  Dover's  powder  in  gruel,  at  bedtime,  to 
be  taken  as  soon  as  the  first  symptoms  manifest  them- 
selves. 

Diseases  of  the  Larynx. — The  larynx,  or  organ  of  voice, 
situated  at  the  entrance  to  the  lungs,  might,  at  first  sight, 
be  thought  to  be  a  frequent  seat  of  disease,  which  it  cer- 
tainly is  not.  Were  the  popular  idea  the  correct  one,  that 
most  of  the  affections  of  the  lungs  arise  from  damp  or  the 
breathing  of  night  air,  it  is  obvious  that  the  delicate  mech- 
anism of  the  larynx  would,  perforce,  share  largely  in  all 
such  consequences,  when,  as  a  matter  of  fact,  congestion 
of  the  mucous  membrane  of  the  larjmx,  in  comparison 
with  congestion  of  the  mucous  membrane  of  the  lung, 
stands  in  the  ratio  of  but  1  to  10,  while  the  comparative 
frequency  of  inflammatory  processes  in  the  two  structures 
are,  perhaps,  as  but  1  to  100. 

Why  this  great  immunity  of  the  larynx,  as  contrasted 
with  the  lung,  from  disease  ?    The  answer  is  comparatively 


DISEASES    OF   THE    LARYNX.  487 

simj^le  :  the  larynx  does  not  share  in  the  purification  of 
the  blood,  and  is  therefore  not  so  liable  to  derangement 
from  poisons  circulating  in  the  blood-stream. 

Cong^estion  of  the  laryngeal  mucous  membrane  occurs  as 
a  transient  condition  whenever  "  a  cold  in  the  head  "  passes 
down  to  the  bronchial  tubes  to  become  "  a  cold  on  the 
chest."  It  is  productive  of  hoarseness  while  it  lasts,  and 
gives  the  cough  a  muffled  sound.  In  public  speakers  and 
singers  overstraining  of  the  organ  of  voice  leads  some- 
times to  a  similar  state  of  matters,  or  again, in  place  thereof, 
to  a  sort  of  atony,  or  partial  paralysis  from  exhaustion,  of 
the  vocal  chords  and  muscles.  This  is  often  spoken  of  as 
a  relaxed  sore  throat,  which  of  course  it  is  not.  For  the 
delicate  it  is  a  good  practice  to  take  a  cup  of  beef  tea,  or 
of  strong  coffee,  or  a  glass  of  dry  sherry  and  a  raw  Q^g,  or 
a  dose  of  coca  wine,  just  before  the  time  of  performance, 
to  obviate  a  breakdown.  In  would-be  public  speakers  a 
course  of  elocution  from  some  one  acquainted  with  the 
structure,  functions,  and  limits  of  power  of  the  human 
larynx  is  advisable,  as  upon  faults  in  the  method  of  speak- 
ing depend  the  majority  of  the  cases  of  breakdown,  such 
as  "  clergyman's  throat." 

Inflammation  of  the  larynx,  or  Laryngitis,  is,  even  in 
adults,  a  rather  formidable  complaint,  and  in  children  is 
attended  with  considerable  risk  to  life. 

It  is  caused,  in  the  otherwise  healthy,  only  by  excessive 
exposure  to  cold  or  dust-laden  air  ;  in  the  subjects  of  any 
form  of  blood-poisoning  it  originates  on  the  least  provoca- 
tion, or  even  without  any  apparent  predisposing  cause;  it  is 
common  therefore  in  drunkards,  in  sufferers  from  Bright's 
disease,  and  in  severe  fevers,  especially  in  typhus.  In 
measles  the  rash  may  first  of  all  be  located  in  the  throat 
and  larynx,  and  transient,  severe  laryngitis,  having  all 
the  symptoms,  but  few  of  the  dangers,  of  croup,  may 


488  DISORDERS    OF    THE    LUNGS. 

precede  by  a  day  or  two  the  appearance  of  the  rash  on 
the  body. 

The  symptomiis  of  laryngitis  are  often  severe.  There 
\^  fever ^  considerable  difficulty  in  breathing,  di  squeaking 
sound  being  noticed  on  inspiration  and  a  whistling  one  on 
expiration  in  bad  cases,  loss  of  voice  or  great  thickness  of 
speech,  a  tickling  cough,  and  sometimes  loccd  pain.  In 
children  the  symptoms  are  even  more  severe,  and  the  dis- 
ease is  marked  by  occasional  paroxysms  of  extreme  diffi- 
culty of  breathing,  the  result  of  spasm  of  the  larynx  set 
up  by  the  inflammatory  mischief.  Laryngitis  is  known 
in  children  as  Croup  (^.  6.,  non-membranous  croup,  as  distinct 
from  membranous  or  diphtheritic  croup,  which  latter  is 
really  diphtheria  of  the  larynx),  and  on  account  of  the 
narrowness  of  the  air-passages,  and  their  extreme  sensi- 
tiveness in  early  life,  it  assumes  always  in  them  a  much 
more  formidable  appearance  than  in  adults. 

The  treatment  of  laryngitis  consists  of  absolute  rest  in 
a  warm  room,  the  temperature  of  which  must  be  kept  uni- 
form ;  in  soothing  inhalations  of  the  vapor  of  plain  or  of 
medicated  water,  and  in  simple  feeding. 

So  grave  a  disease  as  is  croup  in  children  justifies  the 
most  heroic  measures  for  its  relief.  On  the  first  sign  of 
it,  one  of  two  almost  equall}'-  good  courses  should  be 
adopted  :  either  the  larynx  should  be  surrounded  with  a 
cold-water  lead-coil,*  which  may  be  bent  to  shape,  and 
throuflch  which  cold  water  must  be  allowed  to  run  without 
intermission  for  forty-eight  hours  ;  or  enveloped  in  small 
hot  linseed-meal  poultices,  which  must  be  kept  constantly 
in  situ  and  frequently  changed. 

If,  in  spite  of  such  measures,  the  disease  advances, 
tracheotomy,  a  fairly  easy  and  very  hopeful  operation  in 

*  These  lead-coils  are  made  by  Krohne  &  Sesemann,  of  Duke 
Street,  Manchester  Square,  Loudon,  W. 


CROUP    AND    FALSE    CROUP.  489 

simple  croup,  but  little  more  than  a  palliative  of  the  suffer- 
ings in  diphtlieritic  croup,  should,  without  delay,  be  re- 
sorted to. 

Spasm  of  the  Larynx,  False  Croup,  or  Child-crowing,  is 
one  of  the  commonest  disorders  of  early  infancy.  It 
is  a  reflex  spasm,  as  is  usually  that  of  asthma,  and  may 
be  produced  by  indigestion,  by  teething,  by  the  pres- 
ence of  intestinal  worms,  etc.  It  is  rare  after  six  years  of 
age. 

Symptoms. — The  child,  who  is  fairly  well,  wakes  up  (for 
the  attacks  are  more  common  during  sleep  and  at  niglit) 
with  a  start,  sits  up  in  bed  and  makes  violent  efforts  to 
breathe,  the  air  entering  the  chest  with  great  difliculty, 
and  the  acts  of  breathing  producing  a  peculiar  croupy, 
crowing  sound.  Often  the  face  gets  livid,  and  the  eyes 
staring ;  the  child  grasping  the  throat  as  if  to  rid  itself 
of  something  there. 

All  at  once,  when  the  attack  is  at  its  worst,  the  symp- 
toms rapidly  subside,  and  often,  in  a  few  minutes,  the  child 
falls  off  again  to  sleep,  perhaps  to  awake  with  a  similar 
attack  in  a  few  hours. 

As  in  asthma,  so  in  spasm  of  the  larynx,  the  risk  of 
suffocation  is  really  very  small,  and  for  a  similar  reason. 
When  once,  as  a  result  of  the  interference  with  the  breath- 
ing, carbonic  acid  has  accumulated  to  any  great  extent  in 
the  arterial  blood,  it  arrests  all  spasm  and  therefore  cuts 
short  the  attack  when  at  its  worst.  For  this  reason,  spasm 
of  the  larynx  in  infancy  is  only  rarely  fatal. 

The  larynx,  like  other  parts  of  the  body,  may  be  the 
seat  of  cancerous  degeneration  or  of  the  degenerations 
characteristic  of  tertiary  syphilis. 

The  larynx,  like  the  nose,  is  not  unfrequently  the  site 
of  a  polypus,  the  early  removal  of  which,  a  simple  opera- 
tion, is  always  advisable, 
21* 


490  DISORDERS    OF    THE    LUNGS. 

We  Lave  now  completed  what,  after  all,  is  but  a  cursory 
glance  at  the  one  and  only  real  and  independent  S3^stein  in 
man,  the  food  system,  that  in  the  work  of  which  every 
cell  in  the  human  body  is  concerned. 

We  will  now  turn  to  the  three  subsidiary  systems,  off- 
shoots, with  some  specialized  functions  not  purely  aliment- 
ative,  of  the  great  system  we  have  discussed.  First,  we 
shall  discuss  the  great  controlling  or  co-ordinating  mech- 
anism, the  nervous  system,  that  on  the  proper  working  of 
which  depends  the  life  and  action  of  man  viewed  as  a 
country,  as  a  compound  unit,  if  such  a  paradox  be  permis- 
sible, the  sum  of  all  the  individual  cell  actions.  Then  we 
shall  pass  to  a  very  brief  review  of  the  motor  system,  which, 
but  a  branch  of  the  great  food  system,  is  worked  by  the 
nervous  system  with  a  view  mainly  to  the  maintenance,  not, 
as  in  the  food  system,  of  balance  between  one  part  of  the 
body  and  another,  but  of  a  due  state  of  balance  between 
the  whole  body  and  its  general  surroundings.  Finally, 
we  shall  be  compelled  briefly  to  notice  the  reproductive 
system,  which,  while  a  dependent  on  the  food  system  for 
its  powers,  is,  in  its  functions,  more  of  a  supplemental  sys- 
tem, belonging  less  to  the  individual  than  to  the  species. 

In  the  study  of  all  the  systems  we  shall  see  that  a  knowl- 
edge of  their  uses,  of  their  limits  of  power,  of  their  inter- 
dependence, and  of  their  relationship  to  the  entire  body  in 
its  action  as  one  individual,  are  all  necessary  to  us  if  we 
would  avoid  disorder  and  disease,  which  are  ever  the  justly 
apportioned  and  certain  consequences  of  misuse. 


No.  2.— ube  iFletvous  System* 


CHAPTER  XYI. 
FUNCTIONAL  NERYE  DISORDERS. 

THE  NERYOUS    SYSTEM. 

Its  Functions. — Its  Functional  Derangements. 

(a)  Due  to  Kervous  Strain  at  certain  times  of  life : 

Hypochondriasis,  Hysteria,  Mental  Depression,  Temporary  In- 
sanity, etc. 

(5)  Due  to  Impurities  in  the  Blood : 

Depression  of  Spirits,   Irritability,   Sleeplessness,  Neuralgia, 
Hallucinations,  etc. 
(c)  Due  to  Misuse  {Overwork,  etc.)  of  the  Nervous  System: 

Writer's  Cramp,  Delirium  Tremens,  Chorea  (?),  Neuralgia, 
Migraine,  Spinal  Irritation,  Local  Palsies. 

{(I)  Due  to  Reflex  Causes : 

Infantile  Convulsions,  Hj'-steric  and  Hystero-epileptic  Fits,  Ep- 
ilepsy (functional  variety),  Catalepsy,  Tetany,  Functional 
Paralysis. 


Zbc  ncxvowB  system* 


CHAPTER  XVI. 

FUNCTIONAL  NERVE  DISORDERS. 

Firstly,  we  will  discuss  very  briefly  the  ^:>/«;i  of  the 
human  nervous  system,  and  by  the  light  of  that  we  will 
trace  causation  and  consequence  in  the  phenomena  attend- 
ant on  its  disorder. 

Plan  of  the  Nervous  System. 
■     Essentially,  the  nervous  system  consists  of  nerve-cells 
grouped  into  nerve  centres,  and  of  nerves. 

Each  nerve  cell  is  a  species  of  galvanic  cell,  and  its 
function  is  to  generate  a  variety  of  electrical  force  called 
nerve  force. 

Each  nerve  cell  has  a  nerve  going  to  it  (the  afferent 
nerve),  and  conveying  to  it  an  impressio7i  received  in  a 
portion  of  the  body,  and  also  a  nerve  going  from  it  (the 
efferent  nerve),  which  carries  the  motor  force  emitted 
from  the  nerve  cell  as  a  result  of  said  impression. 

Each  nerve  cell  has  also  a  second  outlet  for  motor  force 
— namely,  a  nerve  by  which  it  is  in  direct  or  indirect  con- 
nection with  the  brain.  In  most  nerve  cells,  unless  the  im- 
pression received  has  been  excessive,  no  current  passes  by 
this  second  channel  of  outlet. 


494  FUNCTIONAL    NERYE    DISORDERS. 

Let  US  pause  for  a  simiDle  example.  Ordinary  food  in 
the  intestine  excites  to  ordinary  intestinal  movements  of 
which  we  are  quite  unconscious;  but  let  us  take  a  dose  of 
colocynth,  and  at  once  the  stimulus  to  the  bowel  wall  has 
become  unusual,  and  not  only  is  excessive  movement  of 
the  irritated  portion  of  the  bowel  induced,  but  the  brain 
is  apprised  of  the  fact  by  the  second  channel  of  exit,  and 
we  become  conscious,  painfully  so,  of  the  presence  and 
action  of  an  intestinal  irritant,  and  as  this  impression  going 
to  the  brain  represents  a  force  of  some  kind  and  cannot 
therefore  be  annihilated,  it  is  reproduced  from  other  cen- 
tres* there  as  motor  force,  and  thus  other  muscles,  such  as 
those  of  the  abdominal  wall,  come  to  our  relief  and  assist 
in  expelling  the  colocynth. 

Nerve  centres  of  this  kind — automatic,  or,  as  they  are 
called,  reflex^  because  under  ordinary  circumstances  they 
reflect  as  it  were  the  impressions  they  receive  —  are  ar- 
ranged either  singly  or  in  groups  in  the  tissues,  and 
especially  in  the  spinal  cord,  which  indeed  is  an  admix- 
ture of  columns  of  nerves  going  to  and  from  the  brain  and 
of  these  reflex  centres. 

The  brain  is  a  vast  collection  of  such  nerve  centres,  but 
of  nerve  centres  in  two  stages  of  evolution,  which  may 
here,  for  the  sake  of  simplicity,  be  spoken  of  as  the  lower 
brain  and  the  higher  brain  (usually  styled  lower  and  higher 
brain-centres)  ;  the  former  of  these  is  common  to  the 
higher  mammals,  the  latter  is,  at  least  in  its  most  perfect 
state  of  development,  seen  only  in  man  ;  indeed,  it  is  the 
possession  of  this  higher  brain-centre,  this  higher  brain, 
which  is  the  distinguishing  anatomical  feature  of  humanity. 

Now,  the  lower  brain  consists  essentially  of  avast  group 
of  ordinary  nerve   centres,  packed   closely  together  and 

*  The  group  of  nerve  cells  in  connection  with  all  the  nerves  of 
any  organ  is  called  the  nerve  centre  of  that  organ. 


THE    NERVOUS    SYSTEM.  495 

united  to  one  another  by  nerve  fibrils  ;  therefore,  while 
each  centre  retains  individuality  as  it  were,  inasmuch  as  it 
reigns  over  and  regulates  a  certain  part  of  the  body,  just 
as  do  the  ordinary  reflex  nerve  centres  in  the  trunk,  of 
wdiicli  I  have  already  sj^oken,  yet  to  a  certain  extent  the 
whole  lot  act  together,  sharing  as  it  were  in  each  impres- 
sion received  by  each  member ;  and  this  dispersion,  so  to 
speak,  of  each  impression  is  called  consciousness,  a  phe- 
nomenon common  to  man  and  the  higher  animals. 

The  higher  brain,  at  least  in  its  fullest  development,  is 
the  property  exclusively  of  man,  and  consists  of  a  vast  as- 
sortment of  specialized  nerve  centres,  to  which  some  part 
of  the  impressions  received  by  the  lower  brain  are  im- 
parted, and  where  they  are,  so  to  speak,  "worked  up" 
into  reason  and  the  higher  mental  functions  generally. 

But  while  all  psychologists  go  thus  far,  no  one  has  yet 
been  able  to  explain,  or  indeed  to  conceive,  how  the  mere 
chemical  action  of  food  in  the  blood-stream  on  nerve  cells 
can  result  in  those  great  functions  of  the  brain  collectively 
called  mind.  Xor,  to  my  mind,  is  it  likely  that  a  satis- 
factory solution  will  ever  be  forthcoming,  since  it  seems 
hopeless  to  expect  that  a  group  of  brain  functions  —  in 
other  words,  the  mind— can  form  an  adequate  picture  of 
itself. 

Fortunately  this  psychological  cul-de-sac  will  not  im- 
pede our  study,  nor  need  we  run  our  heads  against  its  dead 
wall ;  it  suffices  for  our  purpose  simpl}^  to  know  that  the 
higher  brain  has,  as  its  function,  the  higher  mind,  reason. 

The  only  source  of  all  cell-force,  and  therefore  of  all 
nerve-force,  is  the  food  in  the  blood-stream. 

Functional  Derangements  of  the  Nervous  System. 
The  functions  of  the  nervous  system,  or  of  any  part  of  it, 
may  be  temporarily  suspended,  to  a  greater  or  a  less  ex- 


496  FUNCTIONAL    NERVE    DISORDERS. 

tent  by  the  operation  of  various  causes.  The  food  supply- 
may,  for  example,  be  deficient  or  impure,  and  in  this  we 
have  perhaps  the  most  frequent  cause  ;  the  nerve  tissue 
may  be  exhausted  from  overwork,  or  a  weak  nervous  sys- 
tem may  be  for  a  short  space  invalided  even  by  what 
may  be  viewed  as  ordinary  labor  ;  and,  lastly,  a  disorder 
in  some  portion  of  the  body  may  lead  to  the  transmission 
of  such  powerful,  such  oft-repeated,  impressions  upon  any 
one  nerve  centre,  or  any  group  of  nerve  centres,  as  to 
throw  out  of  gear — especially  if  the  nerve  tissue  be  debili- 
tated by  want  of  food  or  be  weakly  by  inheritance — brain 
tissue,  far  and  wide. 

We  all  know  the  distressing  vertigo,  the  attacks  of  syn- 
cope, the  short  losses  of  consciousness,  from  which  anoemic 
girls  or  delicate  ladies  in  hot  rooms  so  often  suffer.  In 
these  we  have  examples  of  the  effects  of  a  temporary  de- 
ficiency of  blood — ^.  e.,  of  nerve  food — in  the  brain,  and  a 
consequent  impairment  of  its  functions.  We  know,  or 
have  heard  of,  the  frequency  of  delirium  in  fever.  This 
does  not  arise,  as  was  at  one  time  supposed,  from  inflam- 
mation of  the  brain,  but  from  the  circulation  of  impure 
blood  in  that  organ,  and  is  a  mere  derangement  of  func- 
tion. We  know  the  incapacity  for  further  mentalization 
which  ensues  on  excessive  brain-work,  and  which  is  the 
evident  result  of  brain  exhaustion  ;  while,  as  examples  of 
the  disordering  effect  ensuing,  especially  in  the  neurotic, 
in  the  brain,  from  constant  disorder  in  a  distant  part  of  the 
body,  we  may  cite  the  hysterical  convulsions,  the  teething 
fits  of  children,  the  epileptiform  seizures  which  sometimes 
depend  on  the  presence  of  tape-worm  in  the  bowel,  and 
the  muscular  twitchings  which  are  the  not  uncommon  de- 
pendents on  the  presence  of  a  calculus  in  the  kidney. 

Finally  we  view,  as  further  and  distressing  instances  of 
functional  nerve  disorder,  the  great  depression  of  spirits 


NERVOUS  STRAIN  AT  CERTAIN  PERIODS  OF  LIFE.      49*7 

seen  in  the  gouty  and  the  bilious,  the  direct  consequence 
of  the  circulation  of  impurities  in  the  blood  ;  the  extreme 
melancholy  and  distortion  of  the  judgment  witnessed  in 
the  hypochondriacal,  often  the  result  of  the  same  cause, 
and  the  loss  of  mental  balance,  the  result  of  the  insuffi- 
ciency of  the  blood  supply  to  meet  the  extraordinary  de- 
mands made  by  the  body,  which  often  marks  the  early 
stages  of  puberty. 

After  these  prefatory  remarks,  let  us  pass  to  a  closer 
inspection  of  some  of  the  more  common  and  most  distress- 
ing symptoms  consequent  on  functional  nerve  disorder  ; 
and  here  again,  as  hitherto,  I  shall  work  u^  from  cause  to 
effect  rather  than  adopt  the  ordinaiy  method  of  giving  a 
name,  such  as  hysteria,  to  an  indefinite  group  of  symp- 
toms, which  are  not,  any  of  them,  the  exclusive  property  of 
that  derangement,  and  then  endeavoring  to  trace  their 
causation. 

(a)  Functional  Nerve  Disorders  due  to  Nervous  Strain 
at  certain  times  of  life. 

An  impoverished  state  of  the  blood  does  not,  as  we  have 
seen,  in  itself  lead,  unless  the  nervous  system  be  already 
in  an  exceedingly  enfeebled  state,  to  any  symptom  of 
mental  disorder  ;  on  the  contrary,  provided  the  subject 
remains  quiet,  the  mind  seems  to  grow  clearer  as  the  other 
bodily  organs,  owing  to  their  slow  starvation,  approach 
more  and  more  nearly  to  complete  arrest  of  function. 
Thus  in  death  from  hemorrhage,  from  the  slow  sapping 
of  life  by  inflammatory  phthisis,  or  by  chronic  necrosis  of 
bone,  and  from  advanced  simple  anaemia,  the  head  remains 
almost  to  the  last  moment  clear,  and  the  mind  unclouded, 
while  a  sense  of  hope  and  of  elation  is  not  by  any  means 
uncommonly  present,  even  after  the  patient  has  been  in- 
formed that  all  chance  of  recovery  has  disappeared.     I 


498  FUNCTIONAL   NERVE    DISORDERS. 

have  remarked,  moreover,  repeatedly,  that  when  a  person 
— owing  often  to  the  too-sudden  adojition  of  an  insufficient 
and  exclusively  vegetarian  regime  —  is  losing  flesh  and 
muscular  power  at  what  is  obviously  a  rapid  rate,  he  al- 
most invariably  fails  to  recognize  any  danger  because  of 
this  state  of  mental  calm,  the  mind  becoming,  as  he  would 
well  express  it,  more  refined  and  less  gross.  I  have  always 
regarded,  in  these  cases,  such  a  state  of  the  intellect  as  one 
of  ill  omen,  and  have  known  more  than  one  individual 
who  refused  to  take  warning  by  it  pass  away  raj^idly  by 
consumption. 

It  is  only  when  at  certain  periods  of  life  the  blood  is 
nnable  to  meet  the  call  for  an  extra  suj^ply  of  nerve-food 
that  nerve  disorder  is  witnessed,  and  even  then  mainly  in 
those  whose  nervous  system,  by  misuse  or  by  inherited 
weakness,  is  below  the  normal  strength. 

The  following  are  some  of  the  stages  or  states  in  life  in 
which  these  sudden  calls,  that  test  so  crucially  an  indi- 
vidual's nervous  capacity,  occur  : 

Puberty^  enforced  and  imwilling  celibacy^  parturition^ 
lactation^  and  the  change  of  life. 

It  will  be  remarked  that,  with  the  exception  of  the  first, 
common  to  both  sexes,  the  rest  are  conditions  almost  ex- 
clusively of  female  life,  and  thus  at  a  glance  we  can  under- 
stand why,  apart  from  the  operation  of  other  causes, 
functional  nerve  disorder  is  of  such  exceedingly  common 
occurrence  in  women. 

In  the  male  puberty  is  often  marked  by  Hypochondriasis 
and  extreme  mental  depression,  sometimes  by  actual  men- 
tal disorder.  The  hypochondriacal  fears  are  usually  of 
a  sexual  character,  but  may  take  the  form  of  a  vague 
dread  of  some  disease,  such  as  cancer  or  consumption. 
It  is  needless  to  say  that  the  quack  —  qualified  or  sine 
diploma  —  has  "marked  down"  this  form  of  hypochon- 


NERVOUS  STRAIN  AT  CERTAIN  PERIODS  OF  LIFE.      499 

driac  for  bis  special  prey  and  rarely  fails  to  bag  many  of 
tbe  species. 

In  woman,  in  wbom,  as  in  all  female  mammals,  tbe  sexual 
passion  is — tacite,  O  romancers  of  tbe  "  natural  scbool " — 
normally,  as  compared  witb  tbat  of  tbe  male,  weak,  tbe 
nerve  failures  of  puberty  take  tbe  form  of  depression,  not 
unfreqiiently  tinged  strongly  witb  religious  ideas,  and  but 
very  rarely  witb  tbose  of  a  sexual  nature. 

Enforced  and  unwilling  continence  tells  strongly  and 
powerfully  on  tbe  female  sex,  to  wbicb  it  is  so  largely 
confined  ;  not,  as  some  wbo  judge  of  womankind  in  gen- 
eral by  certain  depraved  or  morbid  specimens  tbereof 
would  bave  us  to  believe,  because  of  tbe  suppression  of 
strong  sexual  passions,  but  by  tbe  denial  to  sucb  women 
of  tbe  instinctive  wisbes  of  maternity,  of  tbe  satisfaction 
of  a  natural  craving  of  tbe  feminine  nature  for  close  affec- 
tion and  for  admiration,  and  of  many  aspirations  only  to 
bo  satisfied  in  tbe  married  state.  Tbis  incessant  mental 
strain,  tbis  worrying  of  tbe  nervous  mecbanism,  aggravated 
at  regular  periods,  in  conjunction  witb  a  lack  of  sufficiently 
engrossing  employment  and  of  tbat  muscular  exercise  so 
necessary  to  appetite  and  digestion  and  to  tbe  due  replen- 
isbing  of  tbe  blood-stream,  directly  produce  tbe  neurotic 
and  tbe  hysterical  woman.  Tbe  system  of  treatment 
adopted  often  greatly  aggravates  tbe  malady.  Tbe  con- 
stant, miscbievous,  and  absolutely  unnecessary  manipula- 
tion, cauterization,  etc.,  of  tbe  womb,  and  tbe  administra- 
tion of  all  tbose  mental  poisons  and  paralyzers,  bromide  of 
potassium,  morpbina,  Indian  bemp,  spirits  of  cbloroform, 
chloral,  etc.,  etc.,  botb  tend  to  lengthen  tbe  attacks  of  hys- 
teria and  to  convert  what  at  first  was  but  a  simple  and 
curable  nerve  derangement  into  an  intractable  morbid 
mental  condition.  Tbe  man  wbo  suggested  in  massage 
tbe  rational  treatment  by  passive  muscular  exercise,  by 


500  FUNCTIONAL    NERVE    DISORDERS. 

enforced  feeding,  and  by  excluding  all  evil  advisers  and 
unwise  synipatliizers,  deserves  well  of  his  race,  and,  though 
his  system  has  been  discredited  by  frequent  mis-usage,  he 
will,  I  venture  to  think,  in  future  ages  stand  out  as  a  giant 
among  the  puny  and  short-sighted  medical  scientists  of 
his  time. 

The  risks  of  mental  disturbance  attendant  on  the  calls 
made  on  the  body  by  parturition,  and  by  the  great  drain 
on  the  blood-stream  involved  in  suckling  the  infant,  are 
well  known.  Like  all  functional  nerve  disorders  due  to 
the  want  of  balance  between  bodily  demand  and  food  sup- 
ply, they  tend,  on  the  return  of  equilibrium  between  these 
two,  to  spontaneous  recovery. 

The  period  that  marks  the  close  of  sexual  life  in  women 
is  one  very  subject,  in  many  cases,  to  perturbations  of  the 
nervous  system,  which  may  take  different  forms.  In  the 
majority  of  cases,  depressio7i  of  spirits  and  great  and  un- 
reasonable irritability  are  the  sole  external  evidences  of 
this,  but  occasionally  alcoholic  or  erotic  tendencies  are  at 
that  period  developed. 

In  addition  to  these  states  of  body  cited  as  predisposing, 
in  conjunction  often  with  improper  feeding  and  heredity, 
to  nervous  functional  disorder,  others,  such  as  those  that 
succeed  to  periods  of  great  excitement  and  worry  during 
wdiich  little  food  has  been  taken  or  assimilated,  might  be 
added. 

What  is,  then,  the  prognosis  in  the  class  of  cases  here 
mentioned  ? 

In  proportion  as  the  nervous  system  is,  by  inheritance, 
sound,  and  rational  means  of  treatment  are  adopted,  the 
outlook  in  nerve  failure  is  hopeful.  Chronic  hysteria  and 
chronic  hypochondriasis  may  in  such  instances  be  un- 
doubtedly cured.  The  causes  at  work  must  first  be  care- 
fully and  diligently  sought  for,  for  they  do  not  always  lie 


HYSTERIA    AND    IIYPOCHONDKIASIS.  501 

on  the  surface.  Many  of  these,  always  morbidly  sensitive, 
sufiFerers  harbor  grievances  and  animosities  with  which,  in 
their  abundant  spare  time,  they,  as  it  were,  scourge  them- 
selves, while  with  some  there  exist,  unsuspected,  actual  de- 
lusions, or  strangely  distorted  views  of  life  and  of  persons. 
The  treatment  consists  in  seeking  for,  and  as  far  as  pos- 
sible removing,  the  cause  ;  in  inducing,  if  possible,  the 
sufferer  to  "  rub  shoulders  "  again  with  the  world  at  large ; 
in  throwing  new  and  wholesome  interest  into  her  life, 
and  in  diligently  persevering  in  every  means  that  can  im- 
prove the  general  physical  health.  Beware  of  the  folly 
of  attempting  to  ridicule  away  the  symptoms.  After  re- 
moving the  cause  of  the  nervous  disorder,  the  cure  may 
be  completed  by  mental  medicine.  In  the  case  of  the 
hypochondriac  a  serious  weighing  of  all  the  symptoms 
and  a  demonstration  to  him  that  they  are  inadequate  to 
account  for  the  serious  disease  dreaded,  an  explanation  of 
his  fears,  and  a  judicious  dwelling  on  the  certainty  of  re- 
covery, will  generally  afford  great  and  prolonged  relief  ; 
while,  if  there  be  any  disorder  present,  as  there  sometimes 
is,  this  must  receive  attention  and  be  put  to  rights.  In 
old-standing  hysteria  the  ministering  successfully  to  the 
mind  diseased  is  often  much  more  difficult,  for  the  patient 
lives  usually  in  an  evil  atmosphere  of  misplaced  sympathy, 
and  among  those  who  have  already  expressed  belief  in  her 
fanciful — or  slight,  but  exaggerated — disorders.  One  fact 
all  people  should  be  thoroughly  acquainted  with — namely, 
that  "  the  presence  of  hysteria  is  incompatible  with  grave 
disease."  To  this  rule  there  are  but  very  few  exceptions. 
The  same  is  true  equally  of  hypochondriasis.  Indeed,  it 
has  often  struck  me  as  extraordinary  with  what  cool- 
ness or  apathy  this  class  of  sufferers  will  face  real  physical 
infirmity  when  attacked  by  it.  Probably  the  weakening 
and  deadening  which  the  nervous  tissue,  in  common  with 


502  FUNCTIONAL    NERVE    DISORDERS. 

all  Other  tissues,  then  undergoes,  is  at  the  root  of  this  dis- 
appearance of  both  hysteria  and  hypochondriasis  in  the 
face  of  organic  disorder. 

Mistreated  hysteria  and  hypochondriasis,  especially  when 
severe,  or  occurring  in  individuals  predisposed  to  mental 
aberration,  may,  however,  end  in  insanity. 

{b)  Functional  Nerve  Disorders  due  to  the  circulation  in 
the  Blood  of  Impurities. 

In  latent  gout  and  rheumatism,  as  in  latent  biliousness,, 
and  in  many  states  of  mal-digestion,  where  imperfectly 
prepared  food  materials,  or  the  actual  products  of  decom- 
position, find  an  entrance  into  the  blood,  nervous  disturb- 
ances are  among  the  most  troublesome  and  the  least  under- 
stood of  the  symptoms  observed. 

Most  of  my  readers  know,  either  by  experience  or  by 
repute,  that  periods  marked  by  neuralgia,  by  great  depres- 
sion and  irrltabiUtg,  by  sleeplessness,  and  sometimes  by 
slight  mental  hallucination,  frequently  precede  and  are 
completely  cured  by  an  attack  of  acute  gout  or  acute  bil- 
iousness ;  but  they  do  not  so  readily  recognize  that  there 
exist  individuals  in  abundance  whose  tissues  cannot,  so  to 
speak,  be  worked  up  to  such  health-restoring  revolutions. 
These,  at  certain  periods  of  life,  when  the  health  has  from 
any  cause  become  a  little  lowered,  as  from  living  on  a  damp 
soil,  or  from  worry  or  an  irregular  system  of  food-taking, 
suffer  for  prolonged  periods  from  extreme  mental  depres- 
sion, which  gets  after  a  time  a  little  better,  only  again  to 
reappear  as  a  sequence  of  any  conditions  adverse  to  the 
bodily  health.  Such  people,  imagining  themselves  hope- 
lessly ill,  and  feeling  life  a  burden  too  great  to  bear,  not 
unfrequently  end  their  days  by  their  own  hand,  when,  if 
they  had  but  known  that  at  the  bottom  of  the  whole 
trouble  there  lay  but  gout  poison,  bile  acids,  or  imperfect 


DEPKESSIOX    OF    SPIRITS.  503 

products  of  digestion,  which,  never  absent  from  the  blood- 
stream, worried  and  fretted  their  nervous  mechanism,  they 
might  have  possessed  courage  to  face  the  enemy.  Cer- 
tainly more  than  90  per  cent,  of  all  the  cases  of  depression 
seen  in  people  under  fifty  years  of  age,  and  who  may  be 
therefore  assumed  to  possess  nerve  tissue  not  as  yet  de- 
generated, admit  of  a  very  simple  explanation  of  the  above 
order,  and  are  but  functional  nerve  derangements  due  to 
impurities  in  the  food  supply  of  the  system. 

There  is  a  characteristic  distinction  by  which  we  may 
rarely  fail  to  make,  independently  of  the  question  of  age, 
a  true  diagnosis  between  depression  of  spirits,  the  result 
of  functional  disorder,  and  the  same  symptom  as  a  sign  of 
threatening  permanent  melancholia,  having  its  end  in  de- 
mentia. The  subject  of  the  former  is  anxious  to  be  treated 
and  is  communicative  ;  the  depression  causes  him  much 
thought,  and  he  usually  has  a  constant  dread  of  insanity. 
The  subject  of  commencing  dementia,  while  evidently 
passing  through  a  period  of  prolonged  gloom,  sitting  alona 
moody  and  silent  for  hours,  rarely  courts  medical  advice 
of  his  own  free-will  and  is  never  communicative.  In  the 
majority  of  cases  such  a  one  will  simply  tell  the  doctor  that 
he  is  "  all  right,"  and  that  he  has  no  symptoms  that  worry 
him  or  that  he  can  discuss.  The  apathy  in  him  forms  a  strik- 
ing contrast  to  the  animation  of  manner  and  the  interest 
in  treatment  shown  by  the  subject  of  mere  hypochondria- 
sis. The  latter,  moreover,  has  no  other  symptoms,  and  indeed 
his  friends  are  usually  quite  unaware  of  his  mental  suf- 
ferings, while  the  former  is  usually  slovenly,  obviously  mis- 
erable and  ill,  and  sometimes  given  to  violent  fits  of  passion. 

In  all  disease  of  the  body  it  may  be  held,  as  a  safe  gen- 
eral rule,  that  the  greater  the  anxiety  of  the  patient  the 
less  his  danger,  and  this  i&  most  strikingly  exemplified  in 
the  derangements  of  the  nervous  system. 


504  FUNCTIONAL    NERVE    DISORDERS. 

The  prognosis  in  all  cases  of  mental  depression,  etc.,  the 
consequence  of  functional  inactivity  of  the  liver  or  of  the 
other  digestive  organs,  producing  impurity  in  the  blood, 
is  hopeful,  however  advanced  the  life  of  the  patient. 

The  treatment  must  of  course  be  directed,  in  the  first 
instance,  to  the  removal  of  the  cause.  The  subject  of 
latent  gout  or  biliousness  should  visit  some  mineral  spa, 
while  the  sufferer  from  dyspepsia  will  usually  do  well  to 
take  a  turn  at  mountain-climbing  or  to  go  salmon-fishing. 
He  must  live  on  simple  food,  and  he  must  earn  it  by  his 
daily  exertions. 

Relief  from  extreme  depression  may,  however,  in  nearly 
all  of  these  cases  be  secured  by  means  of  a  drug,  and  this 
is  especially  the  case  if  gout  be  a  factor  in  its  production. 
In  such  casQS  it  is  often  wise  to  order  : 

Iodide  of  Potassium     ....     1  drachm. 
Aromatic  Spirits  of  Ammonia   .     3  drachms. 
Elixir  of  Peruvian  Bark   ...     1  ounce. 
Mix.    Take  one  small  teaspoonf  ul  in  half  a  pint  of  water 
on  an  empty  stomach  thrice  daily. 

If  the  cause  be  chronic  biliousness,  I  j^refer  : 
Iodide  of  Potassium     ....     1  drachm. 
Chloride  of  Ammonium   ...     2  drachms. 
Elixir  of  Peruvian  Bark  ...     1  ounce. 
Mix.     Same  dose  and  manner  of  taking  it  as  above. 
If,  however,  the  depression  is  not  traceable  to  either  of 
the  foregoing  causes,  tlie  following   will  generally  give 
relief  : 

Bromide  of  Potassium     ...     1  drachm. 
Tincture  of  Nux  Vomica      .     .     1  drachm. 

Caraway  Water 6  ounces. 

Mix.     Dose — One  tablespoonful  in  water  thrice  daily. 

It  is  a  remarkable  fact  that,  while  iodide  of  potassium 

and  bromide  of  potassium  are  among  the  most  depress- 


writer's  cramp.  505 

ing  of  known  drugs  when  given  in  other  iUnesses,  in 
states  of  depression  their  effect  is  usually  of  an  opposite 
nature. 

Among  other  functional  nerve  disorders  due  to  the  pres- 
ence in  the  blood  of  impurities,  may  be  classed  whooping- 
cough  and  tetanus,  which  have  been  placed  and  already 
referred  to,  for  the  sake  of  convenience,  in  another  sec- 
tion ;  while  according  to  some  authorities.  Chorea,  better 
known  as  St.  Vitus's  Dance,  ought  to  come  under  this  head- 
ing, being  in  their  view  generally  the  product  of  rheu- 
matic poison  in  the  blood-stream. 

(c)  Functional  Nerve  Disorders  due  to  a  local  or  general 
transient  debility  of  the  Nervous  System,  the  result  of 
overwork  or  other  misuse. 

Writer's  Cramp,  or  Scrivener^s  Palsy ^  is  a  want  of  co- 
ordinating power  in  muscles  that  have  been  long  accus- 
tomed to  work  together  so  as  to  fulfil  one  function.  It  is 
not  confined  to  those  who  work  with  the  pen,  but  may  at- 
tack any  handicraftsman  as  a  result  of  overwork. 

The  attack  commences  insidiously,  with  a  mere  stiffness 
after  a  long  day's  work,  and  advances  till  writing  or  other 
accustomed  labor  with  the  hand  becomes  an  hnpossibility , 
each  muscle  appearing  to  act  independently  of  the  others  ; 
the  concerted  action  of  the  muscles  necessary  to  the  usual 
work  being  thus  destroyed. 

Strange  to  say,  writer's  cramp  does  not  incapacitate 
the  hand,  as  a  rule,  from  use  at  other  manual  emjoloy- 
ment. 

The  treatment  consists  in  giving  the  hand  complete  and 
prolonged  rest  from  the  work  at  which  it  has  broken 
down.  If  cramp  appears  in  one  accustomed  to  get  his 
living  by  the  pen,  such  a  means  of  livelihood  had  better  at 
once  be  discontinued,  for,  even  if  prolonged  rest  restores 
.22 


506  FUNCTIONAL    NERVE    DISORDERS. 

the  capacity  to  write,  there  will  always  be  a  risk  of  re- 
lapse. An  alternative  plan  that  I  sometimes  recommend 
is  to  learn  writing  with  the  other  hand. 

Alcoholic  Intoxication  and  Delirium  Tremens. — In  the 
first  of  these  we  have  a  temporary  disarrangement  of  the 
nervous  system,  the  consequence  of  an  alcoholic  stimu- 
lant ;  in  the  second,  a  more  prolonged  and  more  severe 
functional  disorder — a  species  of  brief  insanity — the  result 
of  oft-repeated  indulgence  in  nerve  stimulants. 

Chorea,  or  St.  Vitus's  Dance. — This  functional  disorder, 
while  occasionally  connected  with  the  rheumatic  constitu- 
tion, is  commonly  the  sequence  of  a  sudden  fright  in  a 
child,  the  offspring  of  neurotic  parents.  It  is  most  com- 
mon between  seven  and  twelve  years  of  age,  but  may  occur 
in  adult  life,  in  which  latter  case  it  has  often  a  grave  sig- 
nificance.    It  is  most  frequent  in  the  female  sex. 

The  symptoms  of  it  are  briefly  as  follows :  There  are 
ticitchings  hi  the  muscles  of  the  face  and  of  the  extremi- 
ties, which  are  usually  most  marked  on,  and  sometimes  ex- 
clusively confined  to,  07ie  side  of  the  body.  In  bad  cases 
the  head  is  never  steady,  and  the  child  is  unable  to  grasp 
anything  or  to  walk  steadily.  The  twitchings  cease  dur- 
ing sleep. 

There  is  rarely  any  fever,  loss  of  appetite,  or  derange- 
ment of  the  general  health.  In  childhood  and  youth  the 
disorder  ends  almost  invariably  in  recovery. 

Treatment. — The  general  health  should  be  improved,  and 
the  child  should  undergo,  by  itself,  a  regular  course  of 
drill.  It  should  not  associate  much  with  other  children, 
as  they,  by  imitating  the  choreic  movements,  sometimes 
themselves  acquire  the  disorder. 

Neuralgia. — A  functional  nerve  disorder  (usually),  char- 
acterized by  severe  pain  in  one  or  more  nerves.  Caused 
by  debility  from  illness  or  overwork,  by  anosmia,  and  by 


NEUEALGIA    AND    MIGEAINE.  507 

the  circulation  in  the  blood  of  poisons  (notably  of  gout 
poison),  and  by  pressure  on,  or  disease  of,  the  nerve  or  its 
sheath. 

Treatment. — In  inveterate  cases  cut  down  on,  and  stretch 
the  nerve.  In  other  forms  search  for  blood  poison,  espe- 
cially gout  and  syphilis,  or  for  any  of  the  other  causes 
mentioned,  and  treat  accordingly.  The  paroxysm  demands 
relief,  and  the  following  are  among  the  more  successful  of 
the  various  empirical  remedies  : 

Electricity, — The  constant  current  along  the  course  of 
the  nerve,  administered  from  a  Leclanche  battery,  is  often 
effectual. 

Quinine. — 5, 10,  or  15  grains  in  a  single  dose,  which  may 
be  repeated  if  necessary  in  two  hours. 

MorpMna  under  the  skin,  for  adults. 

Chloral. — 15  to  30  grains  in  syrup  of  ginger,  for  adults. 

Butyl- chloral  hydrate  is  often  a  satisfactory,  and,  for 
adults  a  safe,  sedative  in  severe  neuralgia,  and  may  be  thus 
ordered  :  Butyl-chloral,  20  gr.;  syrup  of  Tolu  and  almond 
mixture,  of  each  1  oz.  Mix.  Dose — A  fourth  part  every 
hour  till  pain  ceases. 

Of  external  applications,  the  following  is,  in  my  experi- 
ence, the  best  : 

Camphor,  chloral,  thymol,  and  menthol,  of  each  \  drachm. 
To  be  ground  in  a  mortar  till  a  fluid  is  formed.  The  lini- 
ment to  be  painted  over  the  seat  of  neuralgia. 

Migraine  or  Hemicrania. — A  disorder  usually  confined 
to  one  half  of  the  head,  and  marked,  on  that  side,  by  dhn- 
ness  of  vision  and  great  discomfort.  The  attack  is  at- 
tended often  by  nausea  and  vomiting  (which  brings  relief), 
by  giddiness,  and  sometimes  hj  facial  7ieiiralgia. 

The  attack  is  usually  the  result  of  worry,  fatigue,  over- 
work, or  other  depressing  cause,  acting  on  an  individual  of 
nervous  or  gouty  or  bilious  constitution. 


508  FUNCTIONAL   NERVE    DISOEDEKS. 

JResults  in  recovery. 

Treatment. — Excite  sickness  by  draughts  of  warm  water. 
Afterwards  administer  a  mild  purge.  If  the  attack  re- 
sists these  measures,  infuse  30  grains  of  powdered  guarana 
in  a  teacupf  ul  of  boiling  water  and  sip  the  mixture  as  hot 
as  possible. 

If  these  measures  fail,  try  butyl-chloral  hydrate,  as  for 
neuralgia. 

Spinal  Irritation. — A  symptom  resulting  from  worry  and 
overwork  acting  on  a  person  of  nervous,  and  especially  of 
hysterical,  temperament. 

Characterized  by  the  occurrence  of  neuralgic  pains  in  the 
trunk,  most  often  between  the  ribs,  and  especially  by  spots 
of  7iumbness  or  of  excessive  tendertiess  in  various  regions 
of  the  trunk  and  particularly  over  the  spiiie.  Sometimes 
attended  by  hysterical  paralysis. 

Hesults  in  recovery. 

Treatment. — That  for  hysteria. 

Local  and  Temporary  Palsies. — Paralysis  of  motion  or  of 
sensation  in  almost  any  part  of  the  body  may  be  witnessed 
as  the  result  of  worry  or  excessive  fatigue  in  those  of  neu- 
rotic constitution.  When  associated  clearly  and  evidently 
with  hysteria,  no  importance  need  be  attached  to  the 
symptoms,  and  measures  for  the  general  relief  of  the  hys- 
terical should  alone  be  adopted.  If  local  measures  be 
necessary,  electricity,  in  the  form  of  the  constant  or  of  the 
ordinary  interrupted  current,  is  the  agent  most  likely  to 
be  of  avail. 

{d)  Functional  Nerve  Disorders  due  to  Reflex  Causes. 

The  most  formidable  of  the  functional  disorders  to 
which  the  nervous  system  is  subject  are  traceable  to  reflex 
causes. 

We  have  already,  in  the  earlier  part  of  this  chapter, 


KEFLEX    NERVE    DISORDERS.  509 

seen  by  what  mechanism  this  may  be  brought  about.     Let 
us  now  briefly  recapitulate. 

The  functions  of  animal  life  are  carried  on  by  automatic 
— ^.  e.,  simple  reflex — acts.  The  stimulus  of  food  in  the 
stomach  goes  to  a  nerve  centre  that  sends  back  the  power 
whereby  the  gastric  movements  are  performed  and  the 
necessary  secretion  of  gastric  juice  is  provided.  The 
same  sequence  of  affairs  occurs  in  the  intestine,  liver,  etc. 

But  if  the  impression  on  the  stomach,  intestine,  etc.,  be 
stronger  than  (or,  perhaps  more  correctly,  different  from) 
the  usual  one,  such  as,  let  us  say,  may  be  produced  by 
some  indigestible  ingredient  in  the  food,  then  the  impres- 
sion set  up  by  such  will  travel  beyond  the  ordinary  nerve 
centre,  and  be,  in  part,  transmitted  to  the  brain,  and  we 
shall  become  painfully  conscious  of  exaggerated  intestinal 
movements,  while  the  abdominal  muscles  are  also  set  in 
motion  and  assist  in  the  expulsion  of  the  intruder,  the  in- 
digestible morsel. 

If  such  impression  be  not  only  occasionally  but  con- 
stantly abnormally  strong — in  other  words,  if,  instead  of  a 
morsel  of  undigested  food,  a  tape-worm  be  located  in  the 
intestine — the  incessant  and  abnormal  stimulus  sent  to  the 
centre  in  the  lower  brain  which  is  in  direct  nerve  commu- 
nication with  the  intestine  may  very  easily  extend  in 
time  beyond  that,  its  proper  area,  and  irritate  contiguous 
centres,  and  end  by  setting  up  violent  and  general  mus- 
cular movements  —  the  twitchings  we  see  in  some,  the 
asthmatic  spasms  we  note  in  others,  the  violent  epileptic 
seizures  in  the  worst  class  of  cases.  Of  course,  if,  by 
heredity,  the  nervous  tissue  generally  be  weak  or  faulty, 
a  proportionately  slight  stimulus  will  induce  an  equal 
result. 

But  while  the  reader  can  readily  understand  the  ration- 
ale of  the  process  by  which  a  troublesome  tooth  in  the 


610  FUNCTIONAL   NERVE    DISORDERS. 

infant  gum,  an  inflamed  ovary  or  womb  in  a  delicate  fe- 
male, a  stone  in  the  kidney,  gouty  acid  in  the  stomach,  or 
a  tape-worm  in  the  bowel  of  man,  may  set  up  such  erratic 
muscular  movements  as  are  noticed  in  asthma  and  in  infan- 
tile, hysterical,  or  epileptic  convulsions,  he  may  fail  to  com- 
prehend why,  the  irritation  being  constant  and  slight,  the 
resulting  convulsive  spasms  should  be  periodic  and  violent. 
Nor  is  any  satisfactory  answer  to  this  riddle  as  yet  forth- 
coming. True,  our  great  authorities  speak  of  the  brain 
cells  hoarding  up  the  stimuli  received  and  then  suddenly 
and  explosively  emitting  them,  much  in  the  same  way  as 
a  choleric  man  may  allow  in  silence  aggravation  to  accu- 
mulate until  at  last  he  feels  that  he  can  contain  his  passion 
no  longer  and  gives  free  vent  to  his  feelings ;  but,  unfor- 
tunately, these  similes  are  of  no  scientific  value  whatever, 
being  unsupported  by  facts  of  any  real  weight. 

Let  us  now  treat  briefly,  in  detail,  of  these  reflex  motor 
phenomena. 

Convulsive  Seizures. 

Infantile  Convulsions. — Convulsions  are,  as  all  the  world 
knows,  of  frequent  occurrence  in  infancy.  The  tendency 
to  them  is  at  that  period  of  life,  owing  to  the  extreme 
sensitiveness  to  impressions  of  the  infantile  nervous  sys- 
tem, very  great,  and  what  in  the  adult  would  be  consid- 
ered trivial  causes,  suffice  to  set  them  in  action. 

In  character  they  are  typical  examples  of  functional 
epileptic  seizures.  Teething,  indigestion,  and  the  presence 
of  intestinal  worms  are  the  more  frequent  causes. 

By  way  of  explanation  I  must  here  remark  that  convul- 
sions, not  epileptic  in  character,  and  the  result  of  impuri- 
ties circulating  in  the  blood,  or  of  some  interference  with 
the  aeration  of  the  blood  in  the  lung,  occur  also  frequentl}'' 
in  infancy.  Such  are  common  at  the  commencement  and 
in  the  course  of  the  severer  fevers,  in  whooping-cough. 


INFANTILE    CONVULSIONS.  511 

and  in  severe  bronchitis.  This  variety  of  fit  is  nearly  al- 
ways of  ill  omen^  while  those  of  a  purely  epileptic  and 
reflex  nature  are  rarely  indicative  of  any  great  dano-er. 

The  treatment  of  the  convulsive  seizure  in  a  child  is  sim- 
ple. The  infant  should  be  placed  in  a  warm  bath,  into 
which  mustard  (a  teaspoonful  to  each  quart  of  hot  water 
will  generally  suflice)  has  been  thrown,  and  should  be  kept 
therein  till  the  skin  is  thoroughly  reddened,  when  the  child 
should  be  removed  and  wrapped,  naked,  in  a  hot  blanket. 
These  measures  are  calculated  to  bring  the  blood  to  the 
skin  and  to  relieve  the  deep  nerve  centres.  If  such  meas- 
ures fail,  and  from  the  continuance  of  the  fit  danger  is  to 
be  apprehended,  an  enema  consisting  of  one  tablespoonful 
of  warm  water  and  a  few  grains  of  chloral  (the  amount  to 
be  determined  by  a  medical  man)  will  rarely  fail  to  bring 
the  seizure  to  a  quick  termination. 

Directly  the  child  recovers,  a  purgative  should  be  ad- 
ministered. 

All  causes  leading  up  to  the  fit,  such  as  chronic  irrita- 
tion in  the  bowel  or  in  the  gums,  should  be  attended  to. 

Hysterical  and  Hystero-epileptic  Convulsions. — These  are 
of  all  grades  of  severity  and  may  be  attended  by  all  sorts 
of  phenomena.  The  following  is  the  usual  history  of  their 
occurrence.  The  sufferer  is  the  subject  of  some,  usually 
very  trifling,  abdominal  derangement,  of  w^hich  too  much 
has  been  made  by  foolish  advisers  and  sympathizers,  and 
the  general  health  is  below  par.  To  these  conditions  is 
superadded  some  worry  or  mental  strain,  and  on  this  an 
hysterical  fit.  In  mild  cases  consciousness  is  not  lost,  and 
only  in  the  most  severe  does  all  hold  over  the  control 
powers  of  the  mind  depart,  though  some  very  powerful 
(very  unusual)  stimulus  is  required  to  stir  such  remnant 
of  control  power  to  action.  If  fear  or  indignation  can  be 
aroused  in  the  sufferer's  mind,  she  will  often,  after  a  fit  of 


512  FUNCTIONAL    NERVE    DISORDERS. 

some  hours'  duration,  "  pull  herself  together  "  of  her  own 
free-will  in  a  few  seconds,  and  even  though,  in  appearance, 
she  has  been  quite  unconscious  of  siglit  or  sound. 

The  treatment  of  these  fits  is  that  of  the  complaint,  hys- 
teria, of  which  they  are  part  and  parcel. 

Occasionally,  in  the  sufferers  from  liysteria,  convulsions 
of  an  epileptic  character,  which  character  will  presently  be 
sketched,  set  in.  They  indicate  merely  reflex  disturbance, 
the  causation  of  which  must  be  diligently  sought  for.  Bro- 
mides should  in  these  cases  never  be  resorted  to.  They 
are,  to  the  sufferers,  the  most  deadly  of  poisons,  paralyzing 
fatally  and  forever  the  remnant  of  control  power,  on  the 
strengthening  of  which  alone  rest  our  hopes.  If  the  medi- 
cal man  must  be  heroic  in  treatment,  and  cannot  by  means 
of  the  friends  bring  to  bear  on  the  sufferer  the  moral  and 
mental  medicine  necessary  for  her  cure,  it  is  infinitely  more 
humane  to  sweep  away  with  the  knife  the  ovaries,  and  thus 
bring  sexual  life  and  sexual  disturbance  to  a  premature 
close  (provided,  of  course,  the  seat  of  irritation  be,  as  it 
usually  is,  located  in  the  ovaries)  and  thus  give  the  patient 
a  fair  chance  of  something  approaching  a  cure,  than,  on 
the  plea  of  lessening  the  number  of  convulsions,  to  reduce 
her  by  frequent  and  large  doses  of  bromide  of  potassium 
to  the  hopeless  condition  of  chronic  weak-mindedness  that 
such  treatment  surely  entails. 

Hystero-epilepsy  is  undoubtedly  difficult  to  cure,  and 
its  treatment  is  only  successful  according  to  the  force  of 
the  mental  alteratives — change  of  air,  scene,  and  mode  of 
life — that  can  be  brought  to  bear.  One  of  the  worst  cases 
I  ever  saw,  in  which  the  fit  was  preceded,  or  replaced,  by 
apparently  uncontrollable  homicidal  tendency,  made  a 
complete  recovery  when  she  passed  from  the  condition 
of  a  chronic  hahituee  at  the  out-door  department  of  Lon- 
don hospitals  to  that  of  a  hard-working  mangier  with  no 


EPILEPSY.  513 

one  to  sympathize  with  her  ailments,  to  refer  to  them,  or 
to  treat  them. 

Epilepsy  {of  reflex  character). — Under  the  one  term  epi-. 
lepsy  are  comprised  two  very  distinct  disorders,  the  syraj)- 
toms  of  both  of  which  are,  however,  closely  similar,  while 
the  causation  and  the  prognosis  of  each  are  as  the  poles 
asunder.* 

In  fact  epilepsy  may  be,  and  in  the  majority  of  cases  is, 
a  mere  functional  disorder  of  the  nerve  mechanism,  the 
result  usually  of  a  state  of  chronic  disorder  and  chronic 
irritation  in  some  one  part  of  the  body  —  and  in  infantile 
convulsions,  the  result  of  teething,  we  have  a  typical  ex- 
ample of  such  —  or  of  the  circulation  in  the  blood  of  some 
impurity  leading  to  mal-nutrition  of  the  nerves,  or  per- 
haps, most  usually  of  all,  of  both  the  aforesaid  causes  com- 
bined. That  form  of  it  which  is  the  result  of  actual  brain 
disease  will  be  discussed  in  its  proper  place  under  the  head 
of  Inflammations  and  Degenerations  of  the  N'ervous  Sys- 
tem, the  commoner  functional  variety  alone  occupying  our 
attention  at  present. 

Functional  epilepsy  is  characterized  by  the  occurrence 
at  uncertain  intervals  of  convulsive  seizures,  the  disorder 
being,  according  to  the  severity  of  such  seizures,  known 
as  '''■le  petit  maV  or  "/e  grand  maV* 

The  fits  of  the  '''petit  mal "  are  usually  much  as  follows: 
The  patient  becomes,  often  without  losing  his  feet,  mo- 
mentarily  unconscious,  the  face  being  deadly  ichite  and 
the  eyes  fixed.  Those  of  the  ''grand  maV  are  much  more 
severe.  In  them  some  peculiar  sensation,  such  as  tinglino- 
travelling  up  the  body,  or  pain  in  one  hand,  often  immedi- 
ately precedes  the  fit.    This  warning  is  known  as  the  "  aura 


*  Some  authorities  hold  that  epilepsy  is  due  to  sudden  spasmodic 
constriction  of  the  smaller  arteries  of  tlie  brain,  the  result  of  reflex 
irritation. 
22* 


514  FUNCTIONAL    NERVE    DISORDERS. 

epileptica^''  and  may,  rarely,  take  the  form  of  visual,  audi- 
tory, or  other  sensory  illusions.  In  one  oft-quoted  case 
the  patient  always  said  that  before  each  attack  he  "  felt  a 
smell  of  green  thunder  !"  Directly  after  the  aura,  and 
usually  with  a  piercing  cry^  the  patient  falls  to  the  ground 
and  becomes  rigid,  the  face  being  of  a  deathly  hue.  Usu- 
ally, in  a  minute  or  less,  the  rigidity  of  the  body  gives 
place  to  rapid,  violent,  Sindje7^king  convidsions  of  the  mus- 
cles of  the  face  and  the  body  generally,  the  face  becoming 
livid.  Frothy  matter,  sometimes  tinged  icith  blood,  exudes 
from  the  mouth.  To  this  stage,  after  a  variable  time,  five 
minutes  to  half  an  hour  or  more,  succeeds  a  state  of  qui- 
etude and  torpor  ;  consciousness,  wliich  has  bee^i  abse7it 
throughout  the  attack,  returning  very  slowly. 

These  two  varieties  of  epilepsy,  le  petit  mal  and  le  grand 
mal,  do  not  by  any  means  include  all  forms  of  the  disease, 
for  spasmodic  muscular  contractions  of  epileptic  nature 
may  be  confined  to  one  muscle  or  one  group  of  muscles 
[fTackso7iian  epilepsy),  and  be  unattended  by  complete  loss 
of  consciousness  ;  while  other  varieties,  marked  by  tran- 
sient mental  aberration  and  by  no  convulsions  whatever, 
are  occasionally  witnessed. 

The  treatment  of  functional  epilepsy  is,  when  conduct- 
ed on  the  lines  of  reason,  often  remarkably  successful  in 
those  who  have  been  spared  a  course  of  bromide  of  potas- 
sium. 

In  every  case  a  most  diligent  search,  usually  rewarded 
with  marked  success,  for  the  underlying  cause  of  the  fits 
must  be  undertaken,  as  a  first  step. 

In  severe  epilepsy,  as  in  every  instance  of  severe  hys- 
teria, we  may  take  it  for  granted  that  there  is  present  an 
inherent  debility  —  usually  an  inherited  one  —  of  the  ner- 
vous system. 

Thus  we  have  two  conditions  to  contend  with,  a  distinct 


THE    TREATMENT    OF    FUXCTIOXAL    EPILEPSY.  515 

bodily  ailment  and  a  debility  of  the  nervous  system.  Of 
these  the  first  must  be  definitely  set  to  rights,  while  the 
influence  of  the  second  factor  in  the  complaint  must  be 
circumvented  by  means  of  measures  calculated  to  improve 
the  general  health,  and  therefore  to  restore  and  maintain 
nerve  tone. 

The  diet  is  of  great  importance,  and  this  must,  in  most 
cases,  be  as  low  as  j^ossihle.  I  have  known  many  cases 
of  this  variety  of  epilepsy  radically  cured  by  a  strictly 
vegetarian  dietary,  while  nearly  every  case  is  relieved 
by  its  adoption.  Alcohol  should  be  forbidden,  as  also 
smoking. 

It  is  impossible  to  give  any  other  indications  for  treat- 
ment likely  to  avail,  for  each  case  has  to  be  considered  by 
itself.  The  condition  of  the  sexual  organs  is  often  at  fault, 
and  in  connection  with  them  the  cause  of  much  of  the  epi- 
lepsy of  young  persons  is  to  be  found.  Sometimes,  when 
the  aura  commences  in  one  part,  as  a  finger,  local  meas- 
ures, such  as  the  application  of  the  actual  cautery,  are  de- 
sirable. In  one  case  I  amputated  the  last  joint  of  a  fore- 
finger in  which  the  warning  always  commenced,  and  cured 
the  condition  which  had  lasted  for  years.  Any  treatment 
that  inspires  the  patient  with  confidence  may,  as  in  hys- 
teria, also  effect  a  cure  ;  and  did  space  permit  I  could 
furnish  many  ludicrous  examples  of  the  influence  of  purely 
mental  physic. 

Of  medicinal  treatment  I  have  little  good  to  say.  Bro- 
mide of  potassium  is  a  specious  but  traitorous  friend  to 
the  epileptic,  conferring  on  him,  in  return  for  a  compara- 
tive immunity  from  fits,  a  permanently  damaged  nervous 
system,  and  reducing  him  to  an  absolute  state  of  depen- 
dence on  the  drug.  As  with  potent  purges  in  constipation, 
so  with  the  bromides  in  epilepsy,  once  fairly  entered  on 
the  evil  course,  and  go  forward  the  sufferer  must,  for  if 


516  FUNCTIONAL   NERVE    DISORDERS. 

be  attemjits  to  discontinue  the  drug  or  diminish  the  dos- 
age, the  enemy  that  he  thinks  has  been  vanquished  returns 
with  such  ten-fold  fury  that,  in  epilepsy  at  any  rate,  the 
sufferer  is  forced  to  remain  in  servitude,  becoming  rapidly 
feebler  and  feebler  in  mind  and  body  as  a  result  of  tiie 
bromide  habit.  The  only  medicines  from  which  any  good 
maybe  expected  are  picrotoxin,  in  doses  of  -^^  of  a  grain, 
or  strychnine,  in  doses  of  -^-^  of  a  grain,  in  the  pill  form, 
thrice  daily  ;  but  it  is  well  worthy  of  note  that  in  many 
cases,  20  grains  of  common  bicarbonate  of  sodium,  swal- 
lowed the  moment  the  first  warning  of  a  fit  occurs,  will 
suffice  to  prevent  the  attack.  This  fact  in  itself  is  a  pretty 
clear  evidence  that  to  a  comparatively  trifling  stomachic 
derangement  may  the  final  cause  of  many  an  epileptic  fit 
be  traced. 

Catalepsy  is  a  condition  characterized  by  intermittent 
attacks  of  more  or  less  complete  suspension  of  voluntary 
motor  poioer  and  sensation,  without  convulsions,  but  with 
rigidity  of  muscles,  so  that  the  parts  remain  fixed  in  the 
position  assumed  at  the  commencement  of  the  fit. 

By  mesmerism  an  artificial  catalepsy  may  be  induced. 

There  can  be  no  doubt  but  that,  like  epilepsy,  the  cata- 
leptic state  is  often  the  result  of  reflex  irritation,  the  seat 
of  which  is  not  rarely  in  the  ovaries.  The  sufferer  is 
nearly  always  the  subject  also  of  hysteria. 

Tetany. — -A  localized  rigidity  of  certain  muscles,  usually 
confined  to  those  of  the  hands,  forearm,  and  ankles. 

The  result  usually  of  reflex  irritation,  and  not  uncom- 
mon during  the  period  of  dentition  in  childhood,  but  some- 
times seen  in  adults. 

Resulting,  in  the  vast  majority  of  cases,  in  recovery. 

So  far  we  have  studied  the  phenomena  attendant  on  the 
temporary  liberation  of  excessive  motor  force,  as  shown 
in  convulsions  or  rigidity,  the  results  of  reflex  causes.    Ex- 


REFLEX    PARALYSIS.  517 

traordinary  as  it  may  seem,  tlicrc  are  many  cases  in  which 
the  very  opposite  condition,  that  of  temporary  paralysis 
of  some  muscle  or  muscles,  ensues  from  the  same  cau- 
sation. 

Reflex  Paralysis. — By  what  mechanism  a  constant  and 
distant  irritation,  such  as  may  exist  in  the  womb,  can,  by 
conveyance  to  the  nerve  centres  in  the  spinal  cord  or  brain, 
cause  an  abolition  of  motion  or  sensation  in  a  distant  group 
of  muscles,  is  at  first  sight  difficult  to  comprehend,  espe- 
cially when  it  is  remembered  that  in  most  cases,  excitation, 
and  not  paralysis,  of  such  muscles  is  the  common  result  to 
be  expected.  The  most  likely  explanation  of  this  phe- 
nomenon is  the  following. 

The  nervous  system  controls  the  calibre  of  all  blood- 
vessels, the  special  part  of  the  brain  in  which  this  function 
is  located  being  called  the  vaso-motor  centre.  Now  it  is 
surmised  that  distant  irritation,  especially  that  from  the 
bladder,  kidneys,  intestine,  or  female  reproductive  organs, 
in  those  of  indifferent  nervous  tissue,  may  send  an  impres- 
sion to  this  vaso-motor  centre,  and  that  a  localized  contrac- 
tion of  the  blood-vessels  in  some  part  of  the  spinal  cord 
may  result,  such  contraction  implying  of  course  temporary 
starvation  and  loss  of  function  in  the  reflex  nerve  centres 
situate  in  the  area  affected.  From  this  w^ould  result  local 
paralysis.* 

In  localized  paralysis  it  is  therefore  always  wise  to  seek 
for  a  cause  of  irritation — stone  in  the  bladder  or  kidneys 
is  perhaps  the  commonest  cause  —  and  to  remove  such  an 
irritant. 

Reflex  paralysis,   even   when    it   has   lasted  for  many 

*  Some  maintain  that  the  condition  opposite  to  that  of  paralysis — 
i.  e.,  over-action  of  the  muscles  seen  in  epilepsy,  hysteria,  etc.  —  is 
also  set  up  by  affections  of  the  vaso-motor  centre,  causing  in  those 
cases  a  local  dilatation  of  blood-vessels. 


518  FUNCTIONAL    NERVE    DISORDERS. 

years,  is  a  condition  in  which  complete  recovery  may  be 
hoped  for. 

Mesmeric  States. — In  mesmerism  we  have  a  series  of 
functional  derangements,  closely  allied  both  in  their  phe- 
nomena and  in  the  mechanism  which  produces  them,  to 
the  spasmodic,  cataleptic,  and  paralytic  disorders  which  we 
have  just  described. 

In  mesmerism  the  potent  impression  necessary  to  the 
symptoms  does  not,  however,  come  from  a  distant  internal 
organ,  but  travels  directly  to  the  brain — previously  care- 
iuWj  prepared  to  expect  certain  results — by  the  nerve  chan- 
nels from  the  eyes  and  ears. 

The  will  of  the  mesmerist  has  nothing  whatever  to  do 
with  the  mesmeric  phenomena  in  the  subject,  and  no  effort 
of  the  will  on  his  part  can  produce  any  impression  on  an 
individual  to  whom  previously,  directly  or  indirectly,  no 
clue  has  been  given  as  to  the  likely  direction  of  that  will. 

As  one  might  expect,  mesmerism  can  exert  its  influence 
best  on  those  of  weak  control  power — i.  e.,  the  hysterical 
and  the  neurotic  of  both  sexes,  often  persons  of  great  in- 
telligence, for  the  control  power  of  the  brain  may  be 
feeblest  where  the  intellect  is  brightest.  For  persons  of 
this  class  the  frequent  subjection  to  mesmerism  is  fraught 
with  danger  to  the  mental  equilibrium  ;  they  are  already 
close  enough  to  the  border  land  between  sanity  and  in- 
sanity, and  any  further  weakening  of  control  power  in 
them — such  as  is  the  result  of  repeated  subjection  to  mes- 
merism— may  easily  lead  them  across  the  frontier. 

And  now  we  turn  to  the  organic  disorders,  the  real  dis- 
eases, of  the  nervous  system  of  man,  a  gloomy  record  of 
local  death  in  that  tissue  which  is  most  essential  to  the 
highest  life. 


CHAPTER  XYII. 
ORGANIC   NERVE   DISORDERS. 

THE   NERVOUS  SYSTEM. 

Its  Organic  {Degeneratim)  Diseases. 

1.  Of  certain  Cranial  Nerves  and  of  their  Roots  : 
Bell's  Palsy.  Bulbar  Palsy. 

2.  Of  the  Spinal  Cord  : 

Infantile  Palsy.  Pseudo-hypertrophic  Palsy. 

Creeping  Palsy.  Spastic  Spinal  Palsy. 

Sub-acute  inflammation  of  Locomotor  Ataxia. 

anterior,  gray,  horn,  in  Acute  xisceuding  Palsyo 

the  Spinal  Cord. 

3.  (a)  Of  the  lower  Brain-centres : 
Cerebro-spinal  Sclerosis.  Athetosis. 
Shaking  Palsy. 

{h)  Of  various  portions  of  the  whole  Brain  : 
Apoplexy,  Cerebral  ansemia. 

Cerebral  thrombosis.  "        inflammation. 

"        congestion.  "        softening. 

{c)  Of  Membranes  of  the  Brain : 
Simple  Meningitis.  Pachymeningitis. 

Tubercular  Meningitis.  Hydrocephalus   (water   on   the 

brain). 

4.  Of  the  higher  Bi'ain-centres : 

Insanity,  Dementia,  Organic  Epilepsy,  Sunstroke,  etc. 


Ube    BetVOUS    ^^BtCm—(co7itimied). 


CHAPTER   XVII. 

ORGANIC  NERVE  DISORDERS. 

I.  ORGANIC  DISORDERS  OF  THE  NERVE  FIBRES 

ONLY. 

Inflammation,  which,  according  to  its  severity,  may 
or  may  not  end  in  degeneration,  attacks  nerve  tissue  but 
rarely.  Whenever  it  does  so,  it  at  first  increases,  then 
lessens,  and  often  finally  arrests,  the  functions  of  the  at- 
tacked nerve. 

All  nerve  inflammation  is  called  Neuritis.  Neuritis  of 
the  spinal  nerves»(called  also  "nerves  of  common  sensa- 
tion") may  commence  at  the  termination  of  the  nerve  twigs 
in  the  skin  or  the  muscles,  and  is  then  often  the  result  of 
a  bruise  or  wound  ;  or  it  may  be  the  consequence  of  a 
blood  poison — such  as  mercury,  lead,  gout  poison,  rheu- 
matic poison,  or  syphilis — and  may  in  the  latter  case  at- 
tack the  nerve  (usually  by  inflaming  its  sheath)  at  any 
part  of  its  course.  Whatever  the  cause,  nerve  inflamma- 
tion tends  readily  to  spread  along  the  nerve,  and  paraly- 
sis, temporary  or  permanent,  of  the  nerve  function  is  the 
outcome. 

In  the  case  of  the  spinal  nerves,  sensation  and  motion 
being  their  function,  loss  of  motion  and  of  feeling  in  the 


522  ORGANIC    NERVE    DISORDERS. 

affected  parts  are  the  results  of  their  inflammation.  With 
these  there  is  usually  combined  wasting  of  the  parts. 

The  extremities  are  the  usual  seats  of  attack. 

The  treatment  of  such  paralysis  must  be  directed  to  the 
removal  of  the  underlying  cause,  and,  unless  there  be  actual 
evidence  of  a  severe  wound  or  concussion,  lead,  mercury,  or 
syphilis  will  almost  invariably  be  found  to  be  at  the  bottom 
of  the  mischief.     Complete  recovery  is  net  uncommon. 

Neuritis  of  the  cranial  nerves,  the  nine  pairs  of  "  nerves 
of  special  sensation,"  which  come  from  within  the  skull,  is 
equally  followed  by  arrest  of  their  function.  The  follow- 
ing are,  in  numerical  order,  these  nerves  and  their  special 
duties  in  health  : 

First  Pair — the  Olfactory  N'erves. — These  are  nerves  of 
the  special  sense  of  smell.  They  pass  from  under  the  an- 
terior lobe  of  the  brain  down  into  the  nasal  cavity.  As  the 
result  of  a  severe  blow  on  the  upper  part  of  the  nose,  or 
more  rarely  of  brain  disease,  these  nerves  may  die  and 
their  function  be  completely  lost. 

Second  Pair — the  Optic  Nerves, — These  are  the  nerves 
of  sight.  The  same  causes  as  in  the  olfactory  nerve  may 
lead  to  their  paralysis  and  to  loss  of  vkion.  Neuritis  of 
the  optic  nerves  is  scarcely  ever  followed  by  complete  res- 
toration of  sight. 

Third  Pair — the  Motor  N'erves  of  the  Eyehcdl. — They 
supply  with  motion  the  upper  eyelid,  the  iris  (i.  e.,  the  pu- 
pil), and  the  muscles  that  turn  the  eyes  upwards,  down- 
wards, and  inwards.  Not  unfrequently,  as  the  result  of 
accident,  the  twig  that  supplies  the  muscle  which  lifts  the 
upper  eyelid  becomes  paralyzed,  and  the  lid  droops.  If 
the  whole  of  one  third  nerve  be  affected,  the  eye — or  eyes, 
if  the  pair  of  nerves  be  diseased — is  drawn  downwards  and 
outwards  (^.  e.,  squints  outwards),  and  the  pupil  remains 
large  and  motionless. 


NAMES  AND  FUNCTIONS  OF  THE  CRANIAL  NERVES.     523 

Fourth  Pair  of  Kerves  are  called  the  pathetic  nerves. 
They  assist  in  the  nerve  supply  of  that  muscle  of  the  eye 
by  which  the  eyeball  is  turned  downwards. 

Fifth  Pair  of  Kernes  are  called  the  trifacial,  since  each 
nerve  splits  into  three  parts  ;  they  go  mainly  to  the  face. 

The  first  part  of  the  fifth  nerve  supplies  the  eye  with 
sensibility  ;  the  second  part  endows  with  sensation  the 
nose,  gums,  and  cheeks  ;  the  third  part  supplies  the  an- 
terior two  thirds  of  the  tongue  Vv'ith  taste,  and  a  part  of 
the  cheek  and  the  teeth  with  sensibility,  while  it  also  sup- 
plies the  muscles  of  mastication  with  motion. 

Inflammation  or  degeneration  of  the  fifth  nerve  of  one 
side,  therefore,  means  loss  of  sensibility  of  the  eye  (to  be 
quickly  followed  by  ulceration  and  inflammation  of  the 
eyeball),  loss  of  taste,  and  to  some  extent  of  smell  and  of 
feeling  in  the  face,  on  the  side  affected,  accompanied  by 
loss  of  chewing  power  also  on  that  side  ;  the  face  being 
drawn  towards  the  healthy  side  by  the  power  of  the  un- 
palsied  muscle  there. 

Sixth  Pair  of  Kerves  are  called  the  ahduceiit,  because 
they  supply  the  muscle  that  turns  the  eye  outwards.  Their 
paralysis  results  in  inicard  squinting. 

Seventh  Pair  of  Serves. — Each  nerve  is  divided  into 
two  parts,  the  soft  part  i^p)ortio  mollis)  and  the  hard  part 
(portio  dura),  the  first  of  which  is  the  auditory  nerve,  sup- 
plying hearing  power,  while  the  second  supplies  the  mus- 
cles of  expression  in  the  face  with  motor  power. 

Disease  of  the  soft  part  is  followed  by  deafness,  that  of 
the  hard  part  by  loss  of  expression  and  of  power  to  close 
the  e3^e  on  the  affected  side  of  the  face,  the  mouth  being 
dragged  across  to  the  sound  side.  This  is  a  not  uncom- 
mon form  of  paralysis,  and  goes  by  the  name  of  Bell's 
Paralysis.  Recovery  from  it  is  frequent,  as  it  is  often  due 
to  a  transient  cause. 


524  ORGANIC    NERVE    DISORDERS. 

The  Eighth  Pair  of  Nerves  are  very  complex  in  arrange- 
ment and  function. 

First  part  (the  glosso-pharyngeal  nerve)  supplies  taste 
to  the  back  of  the  tongue  and  motor  power  to  the  tongue 
and  throat. 

Second  part  (the  pneumogastric  or  vagus  nerve)  sup- 
plies the  stomach,  the  heart,  and  the  lungs,  sending  off 
branches,  on  its  way,  to  the  throat  and  box  of  the  wind- 
pipe (the  larynx). 

Third  part  (the  spinal  accessory)  divides  into  two  divis- 
ions, one  of  which  becomes  blended  with  the  pneumogas- 
tric, while  the  other  supplies  two  muscles,  one  of  the  neck 
(the  sterno-mastoid)  and  one  of  the  back  (the  trapezius) 
with  motion. 

It  is  by  means  of  the  channel  afforded  by  the  vagus 
nerve  that  stomach  derangement  can  produce  irregular 
action  of  the  heart,  difficulty  of  breathing,  congestion  or 
even  spasm  of  the  larynx,  and  headache.  Moreover,  its 
distribution  is  wider  even  than  that  just  sketched,  fila- 
ments of  it  blending  with  other  abdominal  nerves. 

Severe  disorder  of  the  eighth  nerve  means  always  death. 

The  Ninth  Pair  of  Nerves  are  called  the  "  hypoglos- 
sal," and  supply  the  tongue  with  motor  power.  When  one 
nerve  is  affected,  the  tongue  on  that  side  is  flaccid,  and  the 
whole  tongue,  when  protruded,  is  dragged  over  so  as  to 
point  with  its  tip  towards  the  sound  side. 

Thickness  of  speech  and  difficulty  of  sioalloicing  are  ac- 
companiments of  palsy  of  this  nerve. 

The  inflammations  and  degenerations  of  the  cranial 
nerves  may  take  their  origin  in  disease  of  that  part  of  the 
brain  from  which  they  spring,  and,  indeed,  this  is  a  com- 
mon cause.*    Pressure  exerted  on  them,  as  by  a  tumor  or 

*  Thus,  loss  of  functional  power  in  one  or  more  of  the  cranial 
nerves  is  a  common  sequence  of  apoplexy. 


ORGANIC    DISEASES    OF    THE    SPINAL    CORD.  525 

by  disease  of  the  bone  channels  tlirongh  which  they  make 
their  exit  from  the  skull,  is,  however,  to  be  kept  in  mind 
as  also  notan  unfrequent  cause  of  their  breakdown;  while, 
finally,  but  perhaps  least  frequent  of  all  causes,  may  blood 
])oisons  be  concerned  in  their  partial  or  complete  loss  of 
function.  The  j^rognosis  and  the  treatment  in  each  case 
must  be  in  keeping  with  the  causation. 

There  is  yet  one  form  of  degenerative  disease,  of  formi- 
dable type,  which  affects  not  one,  but  several,  of  the  cra- 
nial nerves  simultaneously,  and  which  originates  in  degen- 
erative disease  in  the  contiguous  roots  of  nerves.  It  is 
called 

Bulbar  Paralysis. — This  disease  affects  commonly  the 
points  of  origin  in  the  brain  of  the  fifth,  seventh,  eighth, 
and  ninth  nerves.  It  is  marked  by  an  insidious  commence- 
ment. At  first,  a  loss  of  power  over  the  tongue  is  noticed, 
then  a  want  of  expression  in  the  face,  then  a  constantly 
open  state  of  the  mouth,  the  saliva  dribbling  over  the 
dress,  then  some  difficulty  in  chewing  and  swallowing,  all 
of  which  symptoms  become  gradually  aggravated,  the 
mind  often  at  the  same  time  growing  obviously  fi^ebler. 

The  disease  often  lasts  for  years,  death  being  due  to  in- 
terference with  the  heart  or  lungs,  the  result  of  palsy  of 
the  pneumogastric  (the  eighth  cranial  nerve),  or  to  some 
inter-current  attack,  such  as  bronchitis. 

II.  ORGANIC  DISEASES  OF  THE  SPINAL  CORD. 

The  spinal  cord  consists  of  a  central  gray  "matter  com- 
posed of  nerve  cells,  and  in  which  the  special  reflex  func- 
tions of  the  cord  reside,  which  gray  matter  is  arranged  in 
a  double  crescentic  form,  the  crescents  being  placed  back 
to  back,  each  crescent  dividing  its  half  of  the  cord  into 
three  divisions,  made  up  of  columns  of  nerve  fibres  going 
to  or  coming  from  the  brain,  and  known  as  Xho,  cmterior, 


526  ORGANIC    NERVE    DISORDERS. 

the  lateral,  and  the  2^osterior  cohtmns  of  the  spinal  cord, 
the  whole  being  enveloped  and  firmly  bound  together  by 
two  membranes,  the  pia  mater  and  the  dura  tnater,  be- 
tween which  again  a  serous  membrane,  containing  fluid 
and  called  the  arachnoid^  is  placed. 

The  functions  of  the  spinal  cord  are  thus  to  act  as  a 
long  reflex  nerve  centre  and  as  a  conductor  of  impres- 
sions. 

Only  as  the  result  of  severe  injuries,  of  the  pressure  of  a 
tumor,  or  of  great  exposure  to  cold,  is  the  whole  thickness 
of  the  spinal  cord  attacked  by  inflammatory  mischief,  but 
the  gray  matter  alone,  or  one  of  the  columns,  is  not  unfre- 
quently  the  seat  of  a  degenerative  change  which  spreads 
upwards  or  downwards  along  the  special  part  attacked, 
but  does  not  often  involve  the  neighboring  spinal  struct- 
ures. 

(a)  Diseases  of  the  Gray  Matter  of  the  Spinal  Cord. 

Infantile  Paralysis. — The  lesion  in  this  case  is  confined 
to  what  are  called  the  multipolar  cells  in  the  anterior  horn 
of  the  crescent.  It  is  usually  unilateral,  and  therefore  the 
symptoms,  which  are  as  follows,  are  generally  confined  to 
one  side  of  the  body.  One  part  of  the  bod\'',  usually  an 
aria  or  a  leg,  loses  muscular  power  and  ceases  to  grow  in 
keeping  with  the  rest  of  the  body,  remaining  in  adult  life 
infantile  in  size  and  shape  and  almost  useless.  It  is  a 
disease  of  infancy. 

Progressive  Muscular  Atrophy  (Creeping  Palsy). —This 
lesion,  seen  mainly  in  adults,  and  usually  the  direct  con- 
sequence of  overwork  of  a  particular  group  of  muscles  in 
people  who  are  constitutionally  delicate  or  who  are  under- 
fed, is  situated  also  in  the  anterior  horn,  and  gives  rise  to 
symptoms  closely  akin  to  those  of  infantile  paralysis. 
Certain  muscles,  often  those  of  the  hand  and  arm,  begin 


DISEASES  OF  THE  SPINAL  CORD.  527 

to  lose  poiner  and  volume,  the  part  attacked  loasting  even- 
tually and  becoming  perfectly  useless ;  little  more  than 
skin  and  bone  being  left.  Often  both  sides  of  the  body 
are  simultaneously  attacked.  The  spinal  lesion  nearly 
always  extends  to  the  contiguous  gray  matter,  and  then 
produces 

Subacute  Chronic  Inflammation  of  the  Gray  Matter  of  the 
Anterior  Horn  of  the  Spinal  Cord. — A  disease  in  which  many 
of  the  muscles  of  the  body  are  affected,  those  concerned 
in  breathing  and  sicalloicing  being  sometimes  touched, 
the  result  then  being  speedy  death.  Bad  as  is  the  out- 
look when  this  secondary  mischief  follows  on  progres- 
sive muscular  atrophy,  it  must  be  remembered  that,  be- 
ing inflammatory  in  character,  this  latter  disease  may 
always  subside,  leaving  the  patient  no  worse  off  than 
before. 

Pseudo-hypertrophic  Paralysis,  a  disease  of  infancy,  de- 
pendent (according  to  most  observers)  on  a  lesion  in  the 
centre  of  the  gray  matter,  in  which,  while  the  muscles  of 
a  limb  or  limbs  waste,  an  excessive  development  of  con- 
nective tissue  takes  place,  with  the  result  that,  while  the 
limh  grows  larger  than  natural,  it  at  the  same  rate  be- 
comes more  and  more  jyalsied. 

(b)  Diseases  of  the  White  Matter  of  the  Spinal  Cord. 

Spastic-spinal  Paralysis. — A  degeneration  of  the  lateral 
columns  of  the  cord  on  both  sides.  The  earliest  symptoms 
are  a  peculiar  irritability  of  the  legs,  loith  great  increase  of 
tendo- reflex,^'  followed  by  difficulty  in  icalJcing,  j^roducing  a 
stiff,  jerking  gait,  like  that  of  a  Highland  piper.     When 

*  The  tendo-reflex  is  that  involuntary  jerking  forward  of  the  foot 
which  takes  place  when  tlie  forepart  of  the  leg  is  hung  loosely  (as 
over  the  arm  of  a  chair)  and  a  smart  blow  is  given,  with  the  edge 
of  the  hand  or  the  back  of  a  thin  book,  just  below  the  knee. 


528  ORGANIC   NEEVE    DISOEDEKS. 

the  patient  is  sitting,  the  limbs  suddenly  jerk.  The  diffi- 
culty in  uKilkiny  increases  sloidi/,  though  the  limbs  neither 
waste  nor  suffer  any  diminution  of  feeling. 

The  causes  of  the  disease  are  unknown.  The  prognosis 
is  fair,  and  sometimes  (presumably  when  the  lesion  is  in- 
flammatory) recovery  occurs.  The  advance  of  the  dis- 
ease is  very  slow  and  involves  no  danger,  in  itself,  to  life, 
but  is  apt  to  become  complicated,  after  a  time,  with  other 
forms  of  nerve  disease,  especially  with  bulbar  paralysis. 

Locomotor  Ataxia. — A  bilateral  degeneration  of  the  pos- 
terior columns  of  the  spinal  cord. 

Its  onset  is  gradual  and  varied.  Oft  times  the  first  sen- 
sation is  that  as  of  a  tight  cord  constricting  the  body  or 
one  limb.  This  is  due  to  the  irritation  of  a  nerve  or 
nerves.  Sometimes,  in  addition  to  these  ^''girdle  pains^'' 
there  is  a  local  paralysis  of  an  arm  or  leg,  or  even  of  the 
upper  eyelid,  which  then  droops.  "  Lightning  pains " 
shooting  down  the  legs  are  also  among  the  common  early 
signs.  Then  follows,  usually,  incontinence  of  urine. 
Next,  there  is  often  observed — though  this  may  be  a  very 
early  phenomenon — a  difficulty  in  vMlJcing  and  an  inabil- 
ity to  stand  steadily  vnth  the  feet  together  and  the  eyes 
shut.  This  latter  symptom  together  with  abolition  of  the 
tendo-reflex  of  the  knee  are  distinctive  features  of  the  dis- 
ease. Sometimes  a  partial  loss  of  feeling  occurs  in  tlie 
feet,  the  patient  feeling  as  if  the  ground  were  always 
soft;  or  muscular  sense  is  impaired  so  that  there  is  hesi- 
tation in  distinguishing  with  the  hand  differences  in 
weight.  The  eyesight  becomes  affected  in  many  ways, 
the  field  of  vision  becoming  limited  or  color  blindness  be- 
ing developed.  The  skin,  the  kidneys,  and  the  stomach 
become  deranged  in  different  ways.  Eventually  the  cer- 
ebral facidties  themselves  become  impaired. 

The  cause  of  the  spinal  lesion  is  not  unfrequently  syph- 


LOCOMOTOR    ATAXIA    AND    ASCENDING   PARALYSIS.        529 

ills;  sometimes  it  is  apparently  the  outcome  of  sexual  ex- 
cesses; ofttimes  there  exists  no  traceable  cause. 

The  progiK)sis  is  always  very  grave,  though  recovery, 
especially  in  syphilitic  cases,  may  occur,  or  the  progress 
of  the  disease  may  become  arrested.  • 

The  treatment  in  syphilitic  cases  should  be  directed  to 
the  constitutional  taint;  in  other  cases,  medicine  is  worse 
than  useless,  and  all  efforts  should  be  directed  to  the 
maintenance  of  health  by  ordinary  measures,  such  as 
change  of  air,  etc. 

Acute  Ascending  Paralysis.  —  A  degeneration  of  the 
spinal  cord,  confined  (probably)  to  the  middle  of  its  lateral 
columns.  It  is  characterized  by  the  sudden  occurrence  of 
wecikness  in  the  legs,  which  gradually  extends  iqjioards  to 
involve  the  muscles  of  the  trunk  and  arms.  It  is  unat- 
tended  hy  wasting  or  loss  of  sensibility  of  the  affected 
parts,  or  by  cerebral  symptoms.  Usually  it  gradually 
creeps  slowly  to  the  higher  regions  of  the  spinal  cord, 
whose  functions  it  arrests,  causing  in  such  cases  death  by 
interference  with  the  respiratory  and  cardiac  movements. 

Its  treatment  is  unsatisfactory.  No  drug  has  any  effect 
on  it,  but  energetic  means  taken  to  improve  the  bodily 
health  sometimes  are  successful  in  arresting  its  progress. 

To  the  already  formidable  list  of  paralyses,  the  result  of 
spinal  disease,  w^e  have  to  add  Mercurial  and  Lead  Palsy, 
the  former  producing  its  ill  effects  directly  on  the  spinal 
cord,  the  latter  probably  affecting  in  the  first  instance  the 
muscles.  Mercurial  palsy  is,  therefore,  never  completely 
recovered  from,  while  lead  palsy,  if  wisely  treated  in  the 
early  stages,  may  completely  disappear. 

Finally,  it  must  be  remembered  that  the  spinal  cord 

may  be  the  seat  of  a  tumor,  which  by  its  growth,  and  the 

pressure  consequent  thereupon,  may  abrogate  all  spinal 

functions;  or  the  cord  may  suffer  compression  by  reason 

23 


530  ORGANIC    NERVE    DISORDERS. 

of  Lemorrhage,  tlie  result  usually  of  accident,  within  its 
membranes;  or  may  even,  as  the  result  of  injury  or  of 
severe  exposure  to  cold,  become  throughout  its  entire 
thickness  the  subject  of  inflammation,  so-called  Myelitis, 
The  result  in  all  three  events  will  be  much  alike  in  gen- 
eral characters,  and  will  vary,  of  course,  with  the  part  of 
the  cord  affected,  but  in  all  cases  the  muscles  and  other 
structures  supplied  with  nerves  that  branch  off  from  the 
spinal  cord  belong  the  seat  of  lesion  will  gradually  or  sud- 
denly lose  power  and  sensibility,  and  the  muscles  they 
supply  will  then  tend  to  waste  or  even  to  mortify. 

III.  ORGANIC  DISEASES  OF  THE  LOWER  BRAIN 

CENTRES. 
{a)  Those  in  which  both  Brain  and  Spinal  Cord  are  probably 

involved. 

Cerebro-spinal  Sclerosis. — In  this  curious  disease  there 
are  disseminated  over  the  spinal  cord  and  the  lower  brain 
centres  small  patches  of  hardened  tissue  (corpora  amy- 
lacea)  which  consist  of  degenerated  -nerve  tissue.  The 
degenerative  process  is,  however,  not  confined  to  such 
patches,  but  is  of  a  more  general  nature,  the  nerve  tissue 
throughout  the  affected  part  showing  a  tendency  to  an 
increase  in  its  connective  tissue  and  to  a  corresponding 
atrophy  of  real  nerve  substance. 

The  causes  of  these  lesions  are  obscure. 

The  disease  is,  by  reason  of  the  succession  of  the  fol- 
low^ing  symptoms,  divisible  into  three  stages. 

First  stage,  marked  by  peculiar,  irregular  muscular 
movements,  absent  at  first  during  rest,  and  shown  only 
when  the  limbs  attempt  to  perform  their  functions,  by  a 
succession  of  s/uny  jerks,  the  speech  itself  assuming  a 
staccato  charade)'. 

Second  stage,  marked  by  rigidity  of  muscles. 


PARALYSIS    AGITANS    AND    ATHETOSIS.  531 

Third  stage ^  characterized  by  iceakness  of  intellect  and 
failure  of  the  organic  functions. 

The  termination  is  always  in  death,  thouo^h  the  disease 
may  last  for  many  years. 

Paralysis  Agitans  (Shaking  Palsy). — This  disease,  which 
has,  however,  no  fixed  lesion,  is  not  unfrequently  mistaken 
for  the  one  just  described.  The  differences  between  them 
are,  however,  very  considerable. 

The  following  are  the  striking  symptoms  of  shaking 
palsy:  Trembling,  at  first  slight,  and  to  some  extent  under 
the  control  of  the  will,  occurs  in  one  part  of  the  body, 
the  arm,  leg,  or  head,  and  gradually  becomes  more  marked 
and  imcontroUahle.  Unlike  the  movements  seen  in  cerebro- 
spinal sclerosis,  those  in  shaking  palsy  continue  even  while 
the  sufferer  is  at  rest,  and  are  simply  rhythimical  trein- 
hlings. 

Very  slowly  indeed — the  process  often  covering  several 
years — the  shaking  spreads  to  the  other  parts  of  the  body, 
and  is  attended  by  great  muscular  weakness  which  causes 
the  patient  to  bend  forward  on  standing,  and  thus  com- 
pels him,  in  order  to  maintain  his  centre  of  gravity,  to 
run.  This  is  appropriately  called  the  '^ festinant  gaif''  of 
paralysis  agitans,  and  is  quite  characteristic  of  its  ad- 
vanced stages. 

Sometimes  the  course  of  the  disease  is  unmarked  by 
other  symptoms  than  those  detailed,  at  other  times  ^^  gir- 
dle paAns,''''  dyspepsia,  neuralgia,  sciatica,  and  a  long  train 
of  disagreeables  accompany  it. 

The  intellect  remains  clear  to  the  last.  Death  occurs 
usually  as  the  result  of  some  secondary  mischief,  such  as 
bronchitis,  induced  by  the  general  weakness. 

The  cause  of  shaking  palsy  is  not  known. 

Athetosis. — The  nerve  lesion  upon  which  the  symptoms 
of  athetosis  depend  is  at  present  unknovrn.     It  is  char- 


532  ORGANIC    NERVE    DISORt)ERS. 

acterized  by  inahillty  to  retain  the  fingers  and  toes  in  any 
2)osition  in  which  they  may  be  placed,  and  by  their  con- 
tinual sloiv  motion. 

Its  causation  is  obscure;  sometimes  it  succeeds  apo- 
plexy, but  quite  as  often  it  occurs  indej^endently.  Not  in 
itself  a  fatal  disease,  it  indicates  always  a  partial  degen- 
eration of  nerve  tissue,  and  is  therefore  often,  sooner  or 
later,  complicated  by  some  graver  nerve  lesion. 

TAe  treatment  of  the  three  last-named  diseases  is  very 
rarely  followed  by  any  good  result  that  can  be  fairly  ac- 
credited to  a  special  drug.  It  is  strange,  however,  that 
what  must  certainly  be  called  the  best  medicine  to  palliate 
the  symptom,  belladona,  is  itself  cajDable,  in  the  healthy, 
of  producing  the  almost  exact  symptoms  of  these  three 
diseases.  It  must  be  given  boldly,  ten  drops  of  the  ordi- 
nary tincture,  gradually  increased  to  thirty,  being  admin- 
istered thrice  daily  for  a  long  period. 

I  have  occasionally  seen  very  gratifying  results,  of  a 
palliative  nature,  from  its  use. 

{h)  Those  in  which  the  Brain  only  is  involved. 

Cerebral  Heirorrhage,  or  Apoplexy. — We  have  already 
seen  that  degeneration  of  the  arteries  of  the  body  occurs 
sometimes  prematurely  as  the  result  of  changes  induced 
in  their  coats  by  the  rheumatic,  the  syphilitic,  or  the  gouty 
poison,  while  in  old  age  such  a  change  is  a  normal  phe- 
nomenon of  approaching  natural  death. 

Such  degeneration  of  arteries  implies  in  them  loss  of 
elasticity,  brittleness,  and  a  tendency  to  give  way  in  the 
parts  of  the  body  where  naturally  they  have  least  support; 
and  the  brain  is^:)ar  excellence  such  a  part. 

The  symptoms  depend  on  the  seat  of  the  rupture  and 
the  amount  of  the  resulting  hemorrhage.  Thus,  a  mere 
passing  vertigo,  or  a  transient  2^(ilsy  of  an  arm  or  leg,  pro- 


APOPLEXY,  EMBOLISM,  AND    CEEEBRAL    COXGESTION.    533 

longed  or  permanent  loss  of  power  in  one  half  of  the  body, 
or,  finally,  sudden  death,  may,  according  to  the  site  of  the 
cerebral  hemorrhage,  be  the  consequences  of  an  apoplectic 
seizure. 

Equally  may  the  after-effects,  on  tlie  mind,  of  apoplexy 
vary.  Thus,  in  one  man  there  will  result  no  noticeable 
change,  in  another  there  will  be  seen  a  radical  alteration 
in  the  moral  character,  while  in  a  third  there  will  ensue 
general  mental  feebleness,  a  sure  sign  that  extensive  brain 
softening  has  resulted  from  the  presence  of  the  blood-clot 
in  the  brain. 

The  treatment,  in  the  first  few  days,  consists  in  most 
absolute  rest,  and  the  adoption  of  measures  likely  to  lessen 
the  blood  supply  to  the  brain.  These  are,  free  purgation, 
a  low  diet,  and  the  application  of  counter-irritants  to  the 
neck.  Later  on,  every  reasonable  effort  must  be  made  to 
maintain  and  improve  the  general  health  with  the  mini- 
mum of  exertion. 

Cerebral  Thrombosis,  or  Embolism. — In  this  disorder  one 
or  more  blood-vessels  of  the  brain  become  plugged,  and, 
as  a  necessary  consequence,  a  more  or  less  extended  part 
of  the  brain  becomes  temjoorarily  or  permanently  starved 
and  useless. 

The  symptoms  are  akin  to  those  of  apoplexy ,\ivX  gener- 
ally milder;  sudden  death  being  a  rare  result. 

Cerebral  Congestion. — This  is  a  condition  or  state  of  the 
brain,  nearly  always  transient  and  secondary  to  some  dis- 
turbance in  a  distant  part  of  the  body,  rather  than  a  brain 
disease.  The  symptoms  are  usually  icakefalness,  head- 
ache, irritability,  excessive  sensibility,  often  great  excitabil- 
ity, and  sometimes  numbness,  ticitching,  or  slight  paralysis 
in  various  parts  of  the  body. 

Three  forms  of  it  are  described. 

The  apoplectic,  marked  by  vertigo  and  some  loss  of 


534  OEGANIC    NERVE   DISORDERS. 

muscular  power;  the  epileptic^  marked  by  a  distinct  con- 
vulsive fit,  unpreceded  by  any  cry  or  sensation;  the  mani- 
acal^ in  which  there  is  active  delirium. 

The  causes  conducing  to  an  attack  are  over-excitement, 
overwork,  obstructed  circulation,  indulgence  in  alcohol, 
and  liver,  stomach,  or  intestinal  disturbance. 

The  treatment  must  be  adapted  to  the  causation. 

The  prognosis  is  usually  favorable. 

Cerebral  Anaemia,  or  Bloodlessness. — This  is  the  opposite 
condition  to  that  just  discussed,  and  is  usually  the  result 
of  general  anaemia,  defective  heart  power,  loss  of  blood, 
or  of  a  sudden  rise  of  temperature. 

The  symptoms  are,  headache,  faintncss,  giddiness,  i?i- 
ability  for  inental  effort,  pallor,  droicsiness,  dimness  of 
sight,  and,  in  very  bad  cases,  paralysis,  muscular  twitch- 
ings,  and  convulsions. 

The  treatment  consists  in  removing  the  cause. 

Cerebral  Inflammation  and  Suppuration. — Sometimes,  and 
usually  as  the  result  of  severe  injury,  a  part  of  the  brain 
may  inflame.  The  early  symptoms  will  be  those  of  con- 
gestion, the  later  will  probably  be  those  of  brain  compres- 
sion—  ^.  e.,  coma,  muscular  tvntchings,  and  convulsions. 
Sometimes  the  inflammation  will  end  in  Abscess  formation. 
In  the  latter  cases  death  almost  invariably  results.  Ab- 
scess may,  however,  be  dependent  on  other  causes,  as  on 
general  blood-poisoning  or  on  cerebral  thrombosis.  In 
these  latter  the  outlook  is  not  so  grave,  and  recovery  may 
ensue.  In  some  cases  life  has  been  saved  by  trephining 
the  skull  and  evacuating  the  matter. 

Cerebral  Softening. — This  may  be  the  localized  result  of 
apoplexy  or  thrombosis  or  may  be  a  general  process.  It 
is  marked  in  the  latter  case  by  gradually  advancing  men- 
tal loeaJcness  and  general  paralysis,  in  the  former  by  lesser 
mental  and  physical  failures. 


CEREBRAL   TUMORS   AND    MENINGITIS.  536 

Cerebral  Tumors  —  e.  g.^  cancer,  etc. — exhibit  symptoms 
dependent  on  tbeir  size  and  site. 

(c)  Those  in  which  the  Membranes  of  the  Brain  {the  Me- 
ninges) are  alone  involved. 

Simple  Cerebral  Meningitis. — Tlie  meninges,  or  investing 
membranes  of  the  brain,  are  three  in  number:  an  outer 
one,  destined  for  protection  and  called  the  dura  mater ; 
an  inner  one,  the  pia  inater,  crowded  with  small  blood- 
vessels, which  pass  from  it  to  the  brain;  and  an  interme- 
diate, closed,  serous  sac,  analogous  to  the  pleura  and  peri- 
cardium, and  containing,  like  those  structures,  serous  fluid 
— I,  e.,  clear  Ij^mph — and  called  the  arachnoid. 

It  will  hardly  surprise  us,  therefore,  to  know  that  the 
causes  which  lead  to  pleurisy  and  pericarditis  suffice  for 
tlie  production  of  arachnitis,  or  simple  meningitis,  as  it 
is  more  often  called.  Rheumatic  fever,  scarlet  fever,  or 
blood  poison  of  any  kind  may  induce  it,  equally  with  di- 
rect injury  or  severe  exposure. 

The  symptoms  are,  headache,  giddiness,  excitahility,  ex- 
treme sensitiveness  to  noise  or  light,  icaJcefidness^  delirium, 
and  museidar  ticitchings  in  the  ^arly  stage,  torpor  and 
coma  in  the  later  ones,  when  the  brain  is  compressed  by 
the  effused  fluid  in  the  arachnoid  (which  may  become 
purulent). 

Recovery  can  be  hoped  for  only  in  the  milder  cases. 

llie  treatment  consists  in  the  early  and  constant  appli- 
cation of  cold  io  the  head,  in  an  extremely  S2:>are  diet,  in 
pm'gatioji,  and,  if  the  patient  can  stand  it,  in  the  applica- 
tion of  three  or  four  leeches  behind  each  ear.  I  do  not 
think  that  the  administration  of  drugs  is  of  any  avail,  but 
those  from  which  most  may  be  hoped  are  aconite  in  the 
early  stages  and  belladonna  in  the  more  advanced. 

Tubercular  (Scrofulous)  Meningitis. — It  could  scarcely  be 


536  OKGANIC   NERVE    DISORDERS. 

expected  that  scrofula,  pre-eminently  a  disease  of  the  lym- 
phatic system,  would  spare  the  brain,  which  not  only  is 
surrounded  by  a, lymph  space,  but  contains  in  addition  in- 
numerable lymph  channels. 

As  a  matter  of  fact,  in  early  youth,  when  the  brain  is 
undergoing  rapid  growth  and  sj^ecialization,  it  is  frequent- 
ly, in  scrofulous  children,  the  seat  of  tubercle — in  other 
words,  of  consumption.  The  process  generally  commences 
at  the  base  of  the  brain,  and,  as  it  leads  eventually  to  a 
considerable  increase  of  fluid  within  the  ventricles  of  that 
organ,  it  sometimes  goes  by  the  name  of  acute  hydroceph- 
alus, but  the  term  is  a  misleading  one,  being  based  on  a 
secondary  and  not  invariable  symptom. 

Tubercular  meningitis  is  characterized  by  an  insidious 
commencement,  the  child  usually  complaining  of  vague 
pains  in  the  head,  nausea,  and  vomiting,  giddiness,  and 
disturbances  of  sight  and  hearing  in  the  earliest  stages. 
To  these  signs  succeed  squinting,  deliriimi,  muscular 
twitchings,  convulsions,  p>aralysis,  irregular  action  of  lungs 
and  of  heart,  a  peculiar,  oft-repeated  sharp  cry,  and  grad- 
ually deepening  coma. 

Death  is  often  preceded  by  a  return  of  consciousness. 

The  treatment  is  purely  palliative,  for  the  lesion  is  of 
necessity  fatal. 

Tubercular  meningitis  is  the  disease  which  results  from 
the  over -pressure  at  school  of  delicate,  scrofulous  chil- 
dren. 

Pachymeningitis. — By  this  term  is  indicated  a  peculiar 
thickening  of  the  dura  mater,  the  result  sometimes  of  in- 
juries to  the  head,  sometimes  of  alcoholism,  rheumatism, 
or  blood  poisoning.  It  is  often  met  with  in  the  brains  of 
those  who  have  died  insane. 

Hydrocephalus,  or  Water  on  the  Brain. — In  addition  to 
the  lymph  in  the  arachnoid  space,  the  cavities  within  the 


WATER    ON    THE    BRAIN.  537 

brain,  called  the  ventricles  of  the  brain,  which  are  five  in 
number,  contain  also  in  health  a  similar  fluid.  In  delicate 
infants  this  liquid  may  constantly  be  secreted  in  excess, 
with  the  result  that  the  brain  becomes  compressed  and  the 
skull  considerably  enlarged.  This  change  generally  takes 
place  in  the  first  year  of  life,  and  may  even  occur  prior  to 
birth.  Yery  rarely  does  it  commence  in  adult  life,  but  it  is 
sometimes  witnessed  even  then,  and  may,  if  sudden,  lead 
to  what  is  called  "Serous  Apoplexy;"  if  gradual,  to  a  slow 
enlargement  of  the  skull ;  but  in  these  latter  cases  it  is 
generally  combined  with  a  bone  disease,  known  as  osteitis 
deformans. 

Sometimes  an  increase  of  fluid  in  the  arachnoid  accom- 
panies the  effusion  into  the  ventricles. 

Water  on  the  brain  is  generally  a  dependent  of  scrofula, 
the  final  and  determining  cause  being  often  some  trifling 
intercurrent  derangement. 

Complete  recovery  may  occasionally  follow  infantile 
forms  of  the  disorder  ;  much  more  often  partial  recovery 
alone  occurs,  the  child  growing  up  sharp  and  clever  in 
some  things,  but  lacking  mental  balance  and  good  judg- 
ment. The  disease  is,  in  infancy,  not  unfrequently  fatal 
in  a  few  days. 

No  treatment,  beyond  the  adoption  of  simple  measures 
for  the  general  improvement  of  health  is  of  any  avail. 

IV.  ORGANIC  DISEASES  OF  THE  HIGHER  PARTS  OF 
THE  HUMAN  BRAIN. 

Modern  authorities  on  the  subject,  for  the  sake  of  con- 
venience, often  speak  of  the  brain  as  consisting  of  three 
grades  :  a  lower  automatic  one,  possessed  by  man  in  com- 
mon with  all  vertebrates  ;  a  middle  one,  the  seat  of  some 
intelligence,  some  limited  mind,  well  developed  in  all  the 
23* 


538  ORGAXIC    NERVE    DISORDERS. 

higher  vertebrates  ;*  and  an  upper  one,  the  organ  of  the 
purely  human  intelligence,  and  the  possession  of  which  in 
a  state  of  high  perfection  places  the  lowest  healthy  man 
immeasurably  above  the  highest  of  all  other  animals. 

I  have  already  said  that  the  nervous  system  of  the  body, 
though  of  course  an  absolute  essential  to  life,  not  only  in 
man  but  in  all  composite  animals — i.  e.,  of  all  animals  con- 
sistino^  of  manv  cells  working:  tosrether  to  form  but  one 
moving,  sentient  being  —  can  yet  be  regarded,  in  relation 
to  the  great  alimentary  system,  but  in  the  light  of  a  sub- 
sidiary system,  a  development  from  that  food  system  which 
is  the  essential  of  all  life,  and  which  is  well  developed  in 
plants  and  in  the  lowest  animals  innocent  of  any  trace  of 
nervous  tissue.  The  disciples  of  the  Darwinian  school 
therefore,  applying  to  the  nervous  system  their  evolu- 
tionary theory,  maintain  that  the  lower  grade  in  the  brain 
has  been  developed  out  of  ordinary  cell  material,  and  that 
the  two  higher  grades  have,  as  a  direct  consequence  of  the 
unceasinof  struo:orle  for  existence  on  this  earth,  become 
gradually  more  and  more  perfected,  till  thej^  have  culmi- 
nated in  the  brain  of  civilized  man,  whose  attributes  and 
varied  powers  have  placed  in  human  hands  the  absolute 
mastery  over  the  rest  of  the  creation. 

Yet,  though  we  may  speak  glibly  of  three  grades  of  brain 
and  of  their  genesis  from  tissue  concerned  solely  in  the 
alimentary  process,  as  if  w^e  had  in  our  possession  a  com- 
plete chart  of  all  the  nerve  channels,  nerve  functions,  and 
nerve  cells  of  the  brain,  and  a  final  knowledge  of  their 
means  and  modes  of  working  under  the  ordinary  condi- 
tions of  life,  it  must  be  plainly  owned  that,  spite  of  the 
diligent  researches  of  the  most  eminent  physiologists  and 
microscopists,  we  can  as  yet  lay  claim  but  to  a  fair  knowl- 

*  On  pages  494,  495, 1  have  spoken  of  but  two  grades,  including  in 
the  lower  brain  both  the  lower  grades  here  referred  to. 


DEEANGEMENTS  OF  THE  BRAIN.  539 

edge  of  the  lower,  automatic  brain  centres ;  while  of  the 
two  higher  grades,  as  regards  the  manner  in  which  they 
can  manufacture  any  one  of  the  powers  of  the  mind  out 
of  common  physical  impressions,  out  of  the  ordinary 
known  energies  of  Nature,  conveyed  to  their  cells  from 
the  nerve  endings  and  along  the  nerve  twigs  which  stud 
and  traverse  the  body,  and  in  what  conceivable  way  the 
brain  cells  can  retain  for  many  years  that  negative  called 
memory  from  which  to  reproduce,  over  and  over  again,  im- 
pressions and  ideas — all  these  things  remain  to  us  as  great 
a  puzzle  as  ever. 

Such  are  the  insurmountable  difficulties  acknowledged 
by  the  best  neurologists,  and  they  must  form  my  excuse 
for  dealing  with  the  derangements  of  the  higher  human 
brain  only  in  the  following  most  general  manner. 

We  know  that  the  function  of  an  organ  w^anes  and  dies 
in  exact  proportion  as  the  physical  structure,  on  whose 
perfection  its  powers  absolutely  depend,  undergoes  de- 
generation and  nears  its  final  goal,  decomposition.  This 
is  as  true  of  the  brain  and  its  special  function,  mind,  as 
of  the  liver,  stomach,  and  kidneys,  and  of  their  special 
duties. 

Again,  we  know  that  two  conditions  mainly  determine 
the  date  of  failure  in  any  particular  organ — firstly,  its  per- 
fection at  birth  ;  secondly,  the  way  in  which  it  has  been 
used,  the  rate  at  which  it  has  been  worked  ;  and  that,  in 
accordance  wnth  disadvantages  in  these  two  respects,  it 
may  show,  w^hile  yet  the  rest  of  the  body  is  young,  signs 
of  failure  and  premature  breakdown. 

Lastly,  we  have  seen  in  the  case  of  the  many-functioned 
organs,  notably  of  the  liver,  that  a  breakdown  of  any  one  of 
their  functions  may,  and  again  according  to  the  influences 
of  those  two  conditions,  precede  by  many  years  a  general 
failure  of  the  organ,  and  that  thus  a  man  may  be  bilious 


540  ORGANIC    NERVE    DISORDERS. 

in  youth,  gouty  in  middle  life,  and  eventually  glucosuric 
in  old  age.  In  the  case  of  the  brain,  with  its  numerous 
functions,  these  departmental  breakdowns  are  of  many 
and  various  kinds,  and  while  in  themselves  of  evil  omen, 
are  nevertheless  of  use  as  warnings,  as  strong  injunctions, 
to  wisdom  and  economy  which,  when  duly  weighed  and 
acted  upon,  may  often  save  the  subject  from  premature 
dementia. 

Thus  Dementia  is  the  natural  but  distant  goal  of  ail 
mental  life,  and  the  equally  natural  but  near  goal  of  all 
grave  brain  disturbance. 

Let  us  now  briefly  trace  the  influence  of  heredity  and  of 
misuse,  respectively. 

Heredity. — The  influence  of  this  factor  in  mental  failure 
is  the  same  in  kind  in  the  case  of  the  brain  as  in  that  of 
every  variety  of  physical  breakdown.  The  offspring  is  a 
blend,  in  varying  proportions,  of  its  parents  ;  if  these 
have  been  unlike  in  race  and  physical  characters,  the  child 
will  have  all  the  peculiarities  of  each  toned  down ;  whereas, 
if  there  has  been  a  striking  similarity  in  the  distribution  of 
vital  strength  in  both  father  and  mother,  the  offspring  will 
generally — for  the  influence  of  other  conditions  may  al- 
ways possibly  modify  it  —  inherit  a  double  dose  of  their 
special  physical  vices.  This  is  why  the  intermarriage  of 
near  relations,  unless  the  medical  history  of  each  is  singu- 
larly perfect,  is  so  inadvisable,  so  fraught  with  danger  to 
tlie  offspring  of  such  unions. 

Misuse. — To  misuse,  rather  than  to  the  sole  influence  of 
heredity,  is  the  vast  mass  of  insanity  and  of  premature 
dementia  due.  Were  only  a  knowledge  of  the  great  laws 
of  physiology  and  of  our  physical  structure  universal,  in- 
stead of  being,  even  in  the  most  enlightened  circles,  ex- 
ceedingly rare,  much  of  disease,  bodily  and  mental,  which 
we  witness  and  deplore,  might  be  averted.     The  child  of 


DERANGEMENTS    OF    THE    BRAIN.  541 

tlie  neurotic  and  of  the  non-neurotic  are  provided  with  tlie 
same  brain  diet,  and  both  are  too  often  fed  by  force.  The 
feeding  and  the  method  of  doing  it,  in  both  instances, 
are  general!}'  utterly  unscientific,  involving  much  unneces- 
sary wear  and  tear  of  brain  tissue,  but  they  tell  naturally 
most  of  all  on  the  one  who  has  had  the  misfortune  to 
enter  life  a  mental  cripple.  The  absurdity  is  brought 
more  forciblv  to  our  understandino-s  if  we  seek  for  analog^y 
in  other  forms  of  hereditary  Aveakness,  say  in  gout.  Sup- 
pose that  all  children  and  adults,  gouty  and  non-gouty, 
were  subjected  from  early  infancy  to  a  Strasbourg-goose 
system  of  forced  and  full  alimentation.  The  gouty  fami- 
lies would  very  quickly  die  out,  and  this  would,  in  some 
ways,  be  perhaps  a  gain,  were  it  not  that  the  evil  system 
of  feeding  would  convert  many  of  the  non  -  gouty  into 
gouty  subjects,  and  thus  keep  going  or  even  intensify  the 
complaint.  It  is  exactly  so  with  the  brain.  Parents  must 
learn  to  recognize  the  various  forms  of  brain  weaknesses 
in  their  children  and  to  read  correctly  their  earliest  phe- 
nomena, and  in  the  mental  pabulum  to  make  as  skilful  an 
allowance  for  these  peculiarities  as  they  do  in  the  case 
of  the  gouty  and  the  scrofulous  infant.  They  must  learn, 
moreover,  that  generally  it  is  not  in  the  case  of  the  brain, 
any  more  than  in  that  of  the  liver,  the  whole  organ  which 
is  faulty,  but  only  a  part  of  it,  the  rest  being  strong  and 
perhaps  singularly  well  developed. 

Thus,  in  the  neurotic,  the  intellect  is  keen  and  preco- 
cious, the  mental  grasp  rapid  and  sure,  while  the  control 
powers  of  the  brain  are  often  so  faulty  that,  suddenly, 
when  a  brilliant  career,  with  every  inducement  to  perse- 
vere, has  been  opened  to  such  a  one,  the  will  power  in  one 
particular  direction  fails,  and  a  craving  for,  and  a  rapidly 
fatal  indulgence  in,  alcohol  wrecks  every  hope.  In  fact, 
brilliancy  of  genius  is  but  too  often  a  sure  indication  of 


542  OKGANIC    NEKYE    DISORDERS. 

mental  instability  ;  the  very  rapidity  of  manufacture  and 
the  richness  of  the  mental  product  being  but  too  evident 
a  proof  that  a  simultaneous  development  of  all  the  brain 
functions,  essential  to  mental  health,  is  wanting,  and  the 
offspring  of  the  cleverest  people  often  show  by  their  ob- 
vious mental  weakness  how  unhealthy  were  the  parental 
talents,  so  highly  prized  because  so  far  out  of  the  common. 

So  various  are,  however,  the  attributes  of  the  brain,  and 
from  so  many  different  quarters  may,  therefore,  disorder 
spring,  that  in  the  space  at  my  command  I  cannot  venture 
to  give  directions,  but  must  simply  confine  myself  to  a 
strong  recommendation  to  all  parents  who  are  conscious 
in  their  family  history  of  any  form  of  mental  weakness 
to  consult  those  skilled  in  this  great  and  important  subject 
of  the  brain,  and  to  abide  by  their  recommendations  as  to 
their  children's  education  and  the  special  precautions  to 
be  taken  to  avoid  an  undue  strain  being  thrown  on  the 
weak  department. 

But  not  only  should  the  influence  of  heredity  and  the 
skilful  evolution  of  all  minds,  especially  of  the  weaker 
ones,  receive  ever  the  most  judicious  consideration  at  the 
hands  of  all  those  who  have  charge  of  the  young,  but  such 
people  must  also  be  reminded  that  the  brain  is  not  to  be 
viewed  exclusively  as  an  organ  by  itself,  but  as  an  integral 
part  of  the  body,  in  all  whose  trials  and  derangements  it 
must  bear  a  part.  To  avoid  the  onset  of  insanity  in  cases 
where  there  is  the  slightest  predisposition  thereto,  it  be- 
comes, then,  of  the  first  importance  to  maintain  the  stand- 
ard of  general  health  by  judicious  feeding,  by  abundance 
of  recreation,  by  exercise,  by  fresh  air,  and  bj'  other  known 
methods,  as  well  as  to  recognize,  well  in  advance,  the 
periods  of  life  upon  which,  even  in  the  soundest  health, 
unusual  stress  falls  on  the  nervous  mechanism.  We  will 
briefly  notice  these  periods. 


CERTAIN    DANGEROUS    PERIODS    OP    LIFE,  543 

Certain  Periods  in  Life  fraught  vnth  Danger  to  Brains 
Predisposed  to  lAiilure. 

The  first  anxious  period  of  life  is  that  of  puberty.  A 
new  system,  the  reproductive  one,  is  suddenly  added  to 
the  body,  and  makes  demands  on  it  which  should  receive 
due  attention.  The  influence  of  this  change,  always  strong, 
is,  in  my  opinion,  much  more  felt  in  the  male  than  in  the 
female.  In  the  former,  melancholic,  hypochondriac  fears 
or  actual  insanity,  nearly  always  strongly  tinged  with  sex- 
ual passion  (or  sexual  fears),  are  not  uncommon,  while  in 
the  female  the  train  of  disordered  thought  usually  takes 
an  opposite  direction,  and  the  melancholy  or  actual  in- 
sanity is  generally  of  a  religious  character.  It  is  a  com- 
mon medical  experience  to  find  that  the  mind  of  a  sufferer 
has  for  long  been  laboring  under  disorder  ere  the  guar- 
dians or  parents  have  awoke  to  the  fact  that  the  disease  is 
not  depravity,  sullenness,  or  biliousness,  the  treatment  for 
one  of  which  has  done  unbounded  harm,  first  by  derang- 
ing the  health,  and  secondly  by  raising  in-^the  already 
morbidly  sensitive  mind  of  the  sufferer  resentment  at  what 
he  recognizes  as  unjust  treatment  without  being  able  to 
describe  his  real  malady. 

When  adolescence  has  been  passed  without  any  mental 
disturbance  whatever,  the  outlook  for  life  is,  even  in  cases 
marked  by  a  history  of  insanity,  usually  hopeful  as  regards 
the  brain. 

The  other  periods  of  life  which  are  fruitful  in  danger 
are  confined  to  the  female  sex,  and  are  the  menstrual  pe- 
riods, the  times  of  pregnancy,  parturition,  and  suckling, 
and  what  is  called  the  "change  of  life."  Transient  mental 
derangement  in  the  first  of  these  is  by  no  means  rare,  while 
the  dangers  of  insanity  in  those  predisposed  to  it  are  al- 
ways great  in  the   months  that  precede  childbirth,  the 


544  ORGANIC    NERVE    DISORDERS. 

actual  lying-in  period,  and  the  ensuing  time  of  lactation. 
It  is,  however,  at  what  is  called  the  change  of  life  that 
very  often  a  great  interference  with  mental  stability  is 
observed.  Not  nnfrequently  a  woman,  hitherto,  appar- 
ently, endowed  with  much  common-sense  and  temperate 
in  every  habit,  will  at  this  time  become  hysterical  and  ex- 
hibit a  strong  craving  for  alcohol,  while  in  other  cases  a 
chaste  woman  may  become  quickly  transformed  into  a 
beins:  whose  mind  is  crowded  with  erotic  ideas.  Many  of 
these  cases  are  all  the  more  distressing,  inasmuch  as,  the 
stage  of  legal  insanity  not  being  attained,  the  individual  is 
apt  to  be  misjudged,  or,  if  the  real  underlying  cause  of 
mischief  be  discovered,  not  efficiently  treated,  because  she 
cannot  legally  be  placed  under  effective  control. 

It  is  a  popular  saying,  and,  like  all  popular  sayings,  it 
embodies  a  great,  though  an  obscure  truth,  that  the  sub- 
jects of  grave  disorders,  particularly  of  gout  and  asthma, 
both  of  which  we  should,  a  priori,  suspect  of  a  great 
power  of  shortening  life,  live  to  a  good  old  age,  often  dy- 
ino-  from  some  disorder  not  in  apparent  connection  with 
their  lifelong  enemy.  The  same  may  often  be  said  of  the 
neurotic,  including  under  this  term  those  strongly  prone, 
from  any  cause,  to  insanity,  and  eventually  to  premature 
and  complete  mental  failure.  I  have  known  scores  of  the 
latter  who  have,  over  and  over  again  in  the  course  of  their 
lifetime,  been  apparently  on  the  very  verge  of  madness — 
and  one,  a  distinguished  Scottish  writer,  who  had  more 
than  once  voluntarily  placed  himself  under  arrest  and 
supervision  in  an  asylum — and  who  j'et  have  never  once 
been  insane,  but  have  reached  a  full  age,  dying  with  their 
mental  powers  intact.  Sometimes  the  nervous  attacks  are 
distinctly  periodic,  recurring  every  one,  two,  or  three 
years  ;  sometimes  they  recur  at  uncertain  intervals,  their 
advent  being  favored  by  any  greatly  depressing  cause. 


THE    INFLUENCE    OF    CERTAIN    "  NERVE    STORMS."     545 

They  are  always,  however,  succeeded  by  a  restoration  of 
mental  balance  ;  the  mind  being,  for  long  after  their  sub- 
sidence, remarkably  clear.  It  is  exceedingly  uncommon 
for  any  such  individuals  to  become  actually  demented,  for 
these  functional  recurrent  attacks,  like  those  of  gout,  not 
only  do,  though  in  a  way  we  cannot  trace  in  brain  tissue, 
evident  good,  clearing  the  mental,  as  does  a  storm  the 
physical,  atmosphere,  but  they  also,  in  the  vast  majority 
of  cases,  teach  the  sufferer  instinctively  to  shun  such  states 
and  conditions  of  life  as,  by  the  worry  and  mental  anxie- 
ties which  they  induce,  would  be  likely  to  end  in  a  fatal 
overstrain  of  nerve  tissue.  After  all,  how  truly  beneficent 
are  those  bodily  disorders,  those  cell  revolutions,  which  we 
witness  in  the  body  !  It  is  exceedingly  rare  for  the  chronic 
dyspeptic  to  die  of  organic  disease  of  the  stomach,  for  the 
chronic  sufferer  from  uterine  disorder  to  die  of  malignant 
disease  of  the  womb,  for  the  periodic  sufferer  from  bilious- 
ness, gout,  or  glucosuria  to  die  of  organic  liver  disease, 
for  the  man  who  suffers  from  fits  of  nervous  depression,  or 
of  hypochondriasis,  to  die  of  brain-failure  ;  the  vast  ma- 
jority of  those  who  are  attacked  by  organic  disease  of  the 
stomach,  womb,  liver,  brain,  etc.,  have  never  had  a  warn- 
ing, a  single  fear  of  the  catastrophe  which  has  overtaken 
them,  and,  strange  to  say,  when  attacked  they  are,  as  a  rule, 
throughout  the  course  of  the  malady,  apathetic.  There 
is  no  stronger  contrast  than  that  which  is  w^itnessed  be- 
tween the  anxious  attitude  of  a  sufferer  from  some  func- 
tional and  comparatively  unimportant  disorder,  and  the 
indifferent,  half -incredulous  manner  in  which  an  anounce- 
ment  of  the  existence  of  severe  and  unexpected  organic 
disease  is  met.  The  man  who  is  becoming  insane  is  nearly 
always  cheerful  and  jolly  before  his  attack,  and  quite  un- 
conscious of  the  presence  of  any  near  danger,  while,  even 
if  melancholic,  he  does  not  complain  of  the  depression  and 


546  ORGANIC    NERVE    DISORDERS. 

seek  sympathy  and  relief,  but  remains  sullen,  silent,  and 
hopeless,  nursing  in  his  mind  some  embryo  delusion,  but 
unmoved  by  any  threats  of  restraint  in  an  asylum. 

Let  us  now  discuss,  also  in  a  general  way,  the  legal  and 
social  aspects  of  insanity. 

No  satisfactory  definition  of  insanity  has  ever  been  pro- 
duced, nor  is  such  a  definition  conceivably  possible.  The 
functions  of  the  brain  are  so  many  and  so  complex,  and  each 
human  being  is  a  blend  of  so  many  different  people  who 
have  lived  under  such  diverse  environments,  that  no  two 
brains  can  ever,  in  all  their  functions,  their  modes  of  dealing 
with  similar  impressions,  agree.  No  fixed  standard  of  sani- 
ty is,  thus,  possible.  For  the  maintenance  of  social  order,  a 
certain  rough  standard  has  been  prepared  and  is  followed 
in  every  civilized  country,  though  the  codes  of  law  built 
upon  it  necessarily  vary  with  the  race.  Such  a  standard  is 
founded  upon  a  certain  consensus  of  opinion  as  to  the  nec- 
essary relations  of  the  individual  to  society,  and  all  devia- 
tions from  it  are  classed  as  legal  insanity.  For  long  the 
doctors  have  ridiculed  and  abused  this  legal  view,  and  have 
pointed  out  with  perfect  truth  the  unscientific  basis  on 
which  it  rests.  Nevertheless,  a  really  scientific  code  of 
laws  regarding  insanity  would  logically  be  compelled  to 
throw  its  aegis  over  nine  tenths  of  our  criminals,  and  would 
thus  for  a  certainty  tend  to  the  wreck  of  all  society,  while 
being  absolutely  just  as  regards  the  individual. 

The  healthy  brain,  like  all  other  healtliy  bodily  organs, 
follows  and  obeys  strictly  the  physiological  laws  of  life. 
Provided  it  be  healthy  at  the  start,  and  suitably  supplied 
with  blood,  it  guides  its  possessor  through  the  world,  and 
is  itself  unaffected  by  any  special  time  of  life,  being  able 
unmoved  to  meet  the  demands  made  on  it  at  such  periods, 
as  well  as  by  all  the  ordinary  anxieties  and  trials  incident 
to  human  existence.      Its  various  parts  act  together   in 


VARIOUS    MENTAL   TENDENCIES.  547 

thorough  accord  ;  it  manifests  no  great  and  special  brill- 
iancy, except  that  evidently  in  keeping  with  a  careful 
special  training — in  other  words,  it  exhibits  what  may  be 
called  capacity  rather  than  genius. 

All  departures  from  this  type  may  be,  in  proportion  as 
they  fall  off  from  the  standard,  reckoned  as  brains  liable  to 
partial  or  complete  premature  failure,  sometimes  evidenced 
as  actual  insanity  terminating  in  dementia,  but  more  often 
appearing  only  as  occasional  fits  of  despondency,  of  hypo- 
chondriacal fears,  of  defective  control-power,  of  great  irri- 
tability and  depression-  The  biographies  of  many  of  our 
greatest  geniuses  contain  abundant  evidences  of  the  fear- 
ful mental  storms  through  which  they  passed,  states  which 
to  many  are  absolutely  incomprehensible. 

Abnormal  vicious  propensities,  at  least  in  the  absence 
of  any  but  extraordinary  surroundings  ;  a  morbid  craving 
for  excitement,  sympathy,  or  stimulation  ;  irritability ;  ex- 
treme sensitiveness  ;  self-consciousness  and  self-introspec- 
tion, are  all  signs  of  an  abnormal  brain,  while  all  compati- 
ble with  the  existence  of  great  intellectual  power. 

In  short,  the  badly  balanced  and  the  ill-formed  brain 
may  produce  phenomena  of  all  shades  of  vice  and  of 
vicious  tendency,  and  of  all  grades  of  crime.  Fortunate- 
ly for  mankind,  the  blind  vengeance  of  the  law  acts  as  a 
sufficient  deterrent  for  crime  in  all  but  the  worst  cases, 
the  rest  keeping  the  secret  of  those  evil  tendencies,  over 
which  they  have  at  times  such  difficulty  in  obtaining  a 
mastery. 

Dementia,  or  annihilation  of  the  functions  of  that  upper- 
brain  grade  which  is  distinctively  a  human  possession,  is 
the  end  of  all  brain  failure.  In  fact.  Dr.  Clouston,  an  emi- 
nent authority  on  the  subject,  would  simply  define  men- 
tal disease  in  all  its  phases  as  a  "tendency  to  dementia." 


548  ORGANIC    NEKVE    DISORDERS. 

Special  Brain  Disorders,  not,  strictly  speaking,  Insanities. 

Organic  Epilepsy  is  of  this  class.  We  have  already 
spoken  of  reflex  epilej^sy:  we  have  now  to  deal  with  a 
disease  presenting  in  one  of  its  phenomena — the  convul- 
sive seizure — a  close  likeness  to  it,  but  which  in  causation, 
prognosis,  and  treatment  is  an  utterly  distinct  disease. 
According  to  Dr.  Hughlings  Jackson  {Journal  of  Jfental 
Science,  November,  1888),  organic  epilepsy  commences  in 
some  part  of  the  highest  nerve  centres  and  travels  down- 
wards to  affect  the  lower  reflex  ones,  which  latter  are  the 
ones  almost  exclusively  involved  in  functional  epilepsy. 
The  actual  fit  in  both  varieties  is  alike,  though  it  is  usu- 
ally more  severe  and  more  lasting  in  the  organic  form. 
Always  in  organic  ej^ilepsy  is  the  mind,  from  the  very 
first,  affected,  and,  as  the  disease  advances,  this  fact  be- 
comes evident,  and  necessitates  careful  restraint,  for  the 
epileptic  lunatic  is  often  subject  to  uncontrollable  im- 
pulses to  homicide.  The  sufferer  from  this  severe  disor- 
der should  be  placed  early  and  completel}^,  for  his  own 
comfort,  under  the  bromides.  It  is  true  that  these  drugs 
favor  the  advent  of  dementia,  but  they  also  lessen  the 
number  and  severity  of  the  convulsive  seizures  and  the 
tendency  to  deeds  of  violence. 

Sometimes  it  happens  that  the  brain  of  the  incurable 
epileptic  presents  after  death  no  trace  of  any  lesion,  but 
not  unfrequently  also  a  tumor,  a  chronic  brain  abscess,  or 
a  protruding  piece  of  the  inner  table  of  the  skull,  broken 
by  some  accident,  while  the  external  layer  of  bone  has 
escaped  fracture,  is  the  obvious  cause  of  the  malady. 
Cases  are  on  record  where  the  operation  of  trephining  the 
skull  has  resulted  in  the  permanent  cure  of  the  worst 
forms  of  epilepsy. 

Sunstroke  is  a  well-known  disorder,  undoubtedly  affect- 


SUNSTROKE.  549 

ing  primarily  the  brain,  and  often  permanently  impair- 
ing the  mental  powers,  without  showing,  as  adequate  cause 
of  its  mischievous  course,  any  fixed  cerebral  lesion. 

It  is  caused  by  exposure  to  great  heat,  especially  when 
the  air  is  charged  with  moisture  and  the  skin  is  impeded 
in  its  functions;  its  attack  being  favored  by  overcrowd- 
ing, over-exertion,  and  intemperance.  Many  cases  of  sun- 
stroke occur  after  sundown. 

There  are  two  forms-  of  it.  In  the  first,  the  brain  cen- 
tre that  controls  the  heart's  action  is  affected,  and  death 
results  from  simple  heart  arrest;  in  the  second,  there  is 
gradually  deepening  co7na,  with  paralysis  and  convulsions. 
There  exist,  however,  many  mild  forms,  attended  merely 
by  vertigo.,  headache,  and  mental  discomfort. 

The  outlook  as  regards  complete  mental  recovery  is 
never  very  hopeful.  Permanent  impairment  of  the  mind 
and  sometimes  epilepsy  are  occasional  sequences  of  a  se- 
vere attack. 

The  treatment  of  sunstroke  consists  in  absolute  rest  in 
cool,  dry  air,  and  the  constant  application  of  cold  to  the 
head.  By  some  authorities,  purgation,  blistering  of  the 
back  of  the  neck,  and  even  bleeding,  are  recommended. 

In  addition  to  the  above  diseases  it  would  be  easy  to 
add  an  extensive  list  of  less  known  but  kindred  complaints 
in  which  physical  infirmity  foreshadows  mental  failure. 
An  example  of  this  is  seen  in  the  progressive  paralysis  of 
the  insane,  where  sudden  loss  of  voice,  or  difiiculty  in  ar- 
ticulation, due  to  partial  palsy  of  muscles,  often  precedes 
by  months  those  extraordinary  hallucinations  of  fabulous 
wealth  —  a  real  emharras  de  richesse  —  which  mark  the 
commencement  of  rapid  mental  decline. 

In  all  of  these,  however,  as  in  organic  epilepsy  and  sun- 
stroke, the  brain  disorder  is  the  primary  and  only  real  dis- 
order, the  motor  disturbances  being  but  secondary  conse- 
quences thereof. 


No.  s.—Zbc  /IDotor  System, 


CHAPTEK  XYIII. 

DISEASES   OF   THE   MOTOR    SYSTE5C. 

THE  MOTOR   SYSTEM. 

The  Muscles: 

Their  Functional  and  Organic  Disorders. 
TTie  Ligament. 
The  Bones  : 

(a)  Their  Functional  Disorders. 

(b)  Their  Organic  Diseases. 

Caries. 

Necrosis. 

Periostitis. 

(c)  Their  Degenerations. 

Rickets. 
Osteomalacia. 
Osteitis  deformans. 


Ube  /iDotor  S^stem^ 


CHAPTER  XVIII. 
DISEASES  OF  THE  MOTOR   SYSTEM. 

The  org^aiis  of  the  motor  svstem  are  the  muscles,  bones, 
and  lio^aments. 

Motion  and  locomotion  of  the  human  body  are  per- 
formed by  a  system  of  leverage,  of  which  the  joints  sujd- 
ply  the  fulcra^  the  bones  the  levers^  and  the  muscles,  by 
means  of  the  energy  stored  in  their  cells  and  derived  from 
the  combustion  of  food,  the  poicer. 

The  direction  of  the  movement  is  under  the  control  of 
the  nervous  system,  down  the  fibres  of  which  pass,  to  the 
muscle  cells  which  it  is  purposed  to  work,  the  impulse 
necessary  to  set  free  th-e  stored  energy,  the  effect  of  which 
is  to  cause  a  contraction  in  such  cells  and  thus  to  set  up 
movement  in  the  levers  (the  bones)  to  which  the  muscles 
are  attached. 

The  muscles  are  connected  with  the  bones  by  smooth 

tendons. 

THE  MUSCLES. 

Of  these  there  are   two  distinct  kinds,  the  red,  volun- 
tary,   and    striped    muscles,    exceedingly    rich    in    blood 
(whence  their  color),  under  the  control  of  the  will,  and 
attached  to  the  bones;  and  the  white,  involuntary,  and 
24 


554  DISEASES    OF   TUE    MOTOR   SYSTEM. 

iinstriped  muscles,  much  less  abundant,  not  under  will 
control,  and  not  attached  to  muscles,  but  found  in  the 
walls  of  hollow  cavities,  such  as  the  stomach  and  bowels. 
The  heart  forms  an  exception  to  the  rule,  for  it  is  a 
hollow  muscle,  whose  fibres  consist  of  involuntary,  but 
striped,  muscular  fibre. 

The  Functional  Derangements  of  Muscles. 

By  reason  of  an  impure  or  an  imperfect  blood  supply, 
or  by  reason  of  loss  of  power  in  the  motor  nerves  which 
pass  to  them,  muscles  may  lose  partly  or  completely  their 
power  of  movement,  either  temporarily  or  permanently. 
It  does  not  follow,  however,  that  under  all  such  conditions 
a  muscle  will  waste,  for  this  will  depend  largely  upon  the 
implication  in  the  disease  of  the  nerves  which  regulate 
the  calibre  of  the  blood-vessels  that  supply  the  muscle 
cells.  Nor  may  sensation  be  necessarily  abolished  or 
diminished  when  motor  power  is  in  abeyance,  for  that 
again  depends  upon  the  condition  of  the  sensory  nerves 
which  pass  from  the  muscle  to  the  spinal  cord  and  brain. 
On  the  other  hand,  sensory  or  trophic  (nourishing)  nerve 
force  may  be  impaired,  while  motor  power  may  be  but 
little  affected. 

Pain,  without  obvious  cause,  may  be  experienced  in 
raiiscular  tissue,  and  may  be  of  rheumatic  or  gouty  origin 
or  due  to  an  impoverished  or  tainted  blood  suj^ply. 
Though  this  symptom  may  occur  in  any  muscle,  it  is  par- 
ticularly common  in  the  muscular  tissue  which  clothes  the 
left  front  of  the  chest  wall,  when  it  is  called  Pleurodynia. 
The  treatment  of  troublesome  chronic  muscle  pains  con- 
sists in  improvement  of  the  general  health,  which  is  always 
deranged,  in  exercise  of  the  muscles,  in  fresh  air,  a  simple 
dietary,  frequent  baths,  and,  if  necessary,  in  friction  over 
the  painful  part. 


THE    LIGAMENTS. — THE    BONES.  555 

Degenerative  Diseases  of  Muscles. — Muscles  may  be  the 
scat  of  tumors  of  various  kinds,  of  abscesses,  of  effusions 
of  blood,  etc.  To  one  form  of  degeneration,  the  fatty 
one,  they  are  very  prone.  Muscles  long  paralyzed  under- 
go often  this  change,  becoming  then  permanently  useless, 
while  after  severe  fevers,  and  in  chronic  debilitating  dis- 
ease, this  degeneration  may  often  be  seen  attacking,  here 
and  there,  some  one  or  more  muscles  or  groups  of  mus- 
cles. In  these  latter  cases,  if  the  general  health  improves, 
complete  recovery  may  be  secured. 

THE  LIGAMENTS 

consist  of  bundles  of  delicate,  non-elastic  fibres  bound 
firmly  together.  Their  function  is  to  support  the  joints, 
uniting  the  ends  of  contiguous  bones,  which  they  some- 
times completely  surround. 

The  ligaments  are  not  verj^  liable  to  be  attacked  by 
primary  disease,  but  they  are  commonly  involved  in  joint 
disease  produced  by  rheumatism,  gout,  degenerative 
changes,  etc.,  and  may  then  be  partially  or  completely 
destroyed. 

THE  BONES 

are  of  two  kinds,  the  cartilaginous  and  the  osseous,  the 
former  being  a  preliminary  stage  of  the  latter — ^.  e.,  all 
bone  is  at  first  cartilage,  the  cells  of  the  latter,  as  develop- 
ment advances,  gradually  secreting  hard,  bony  material. 
The  bones  consist,  when  fully  developed,  of  about  one 
third  animal  matter  (living  cells,  etc.)  and  of  two  thirds"^ 
bony  deposit.  They  are  abundantly  supplied  throughout 
their  entire  thickness  with  blood-vessels. 

All  bone  is  completely  surrounded  by  a  dense  fibrous 
sheath,  called  the  peHosteum,  which  is  very  richly  sujd- 
plied  with  blood  and  plaj^s  a  leading  part  in  the  nutrition 
and  growth  of  bone. 


556  DISEASES    OF    THE    MOTOR    SYSTEM. 

Functional  Disorders  of  Bones. 

It  is  questionable  whether  there  are  really  any  disor- 
ders that  come  under  this  heading,  for  though  "  aching 
of  the  bones  "  is  indeed  a  frequent  complaint,  the  actual 
seat  of  pain  in  those  cases  is  almost  invariably  the  syno- 
vial membranes  of  the  joints,  or  the  ligaments  and  ten- 
dons appertaining  to  them,  or  the  muscles  of  the  j^art,  or, 
more  rarely,  the  periosteum  of  the  bone,  all  of  which  are 
liable,  by  reason  of  rheumatism,  syphilis,  mercury,  gout, 
or  other  blood  poison,  to  painful  disorders. 

Organic  Disease  of  Bone  and  of  its  Periosteum. 

Inflammatory  Disorders  ending  often  in  Degenerative 
Caries. — By  this  term  is  understood  a  limited  inflamma- 
tion of  bone  ending  in  softening  and  disintegration  of  the 
portion  attacked,  accompanied  usually  by  suj^puration  of 
surrounding  muscular  tissues — ^.  e.,  by  abscess.  It  at- 
tacks most  commonly  the  spinal  bones,  the  short  bones, 
and  the  ends  of  the  long  bones  of  the  arms  and  legs. 

The  cause  is  to  be  traced  to  a  local  breakdown  in  the 
lymphatic  system,  the  consequence  of  scrofula,  syphilis, 
or  mercurial  poisoning.  In  syphilis  the  bones  of  the  head 
are  often  the  seat  of  the  disease. 

The  symptoms  are  obscure  at  first  and  usually  attribut- 
ed to  rheumatism.  There  is,  then,  deep-seated  ^^ain,  worse 
generally  at  night;  to  this  succeeds  after  a  time  local 
swelling  and  redness;  then  the  formation  of  an  abscess,  in 
the  discharges  from  which  spicules  of  dead  bone  occur. 
At  the  bottom  of  the  abscess  may  readily  be  felt  with  a 
probe  the  bared,  crumbling  bone  tissue. 

The  treatment  consists  in  improvement  of  the  general 
health,  and  in  surgical  measures  calculated  to  remove 
thoroughly  the  diseased  bone.      When  -radical  steps  in 


NECROSIS    AND    PERIOSTITIS.  557 

this  disease  are  not  early  undertaken,  the  abscess  contin- 
ues to  discharge,  the  health  fails,  and  the  osseous  disease 
advances  to  threaten  life  by  its  consequences. 

Necrosis. — By  this  term  is  implied  death  of  a  large  piece 
of  bone,  not  by  slow  crumbling  as  in  caries,  but  by  some 
interference  with  the  main  blood  supply  of  a  considerable 
portion  of  a  bone,  the  diseased  part  coming  away  in  one 
or  more  pieces. 

The  seats  of  disease  are  generally  the  last  joint  of  the 
finger,  the  result  sometimes  of  whitlow;  the  skull  or  col- 
lar-bone, the  sequence  of  syphilis;  the  lower  jaw,  the  con- 
sequence of  the  irritating  fumes  of  phosphorus  coming 
in  contact  with  decayed  teeth  in  match-makers;  and  the 
shafts  of  the  long  bones  of  the  extremities  in  scrofulous 
children. 

Scrofula,  syphilis,  mercury,  and  phosphorus  fumes  are 
the  causes  of  nearly  all  cases  which  arise  without  sufficient 
external  injury  to  account  for  the  violence  and  extent  of 
the  disease. 

The  treatment  is  the  same  as  that  for  caries,  but  surgi- 
cal procedures  are  more  necessary  and  more  severe. 

Periostitis. — When  the  sheath,  or,  as  it  is  called,  the 
periosteum,  of  bone  becomes  inflamed,  a  state  of  mattei-s 
by  no  means  rare,  the  following  are  the  symptoms  gener- 
ally observed. 

There  is  localized  pain  of  a  sharp,  rheumatic  character, 
aggravated  by  heat,  and  therefore  worse  at  night.  In  ad- 
dition to  this,  on  passing  the  finger  over  the  bone  there 
wiir  generally  be  no  difiiculty  in  detecting  a  hard  swell- 
ing on  its  surface,  called  a  node,  and  due  to  an  effusion  of 
lymph  between  the  hard,  unyielding  periosteum  and  the 
bone.  When,  as  in  scrofula,  syphilis,  and  mercurial  poi- 
soning, the  process  is  a  slow  one,  there  will  often  appear, 
for  a  long  time,  no  further  symptoms,  and  the  lymph  will, 


558  DISEASES    OF    THE    MOTOR    SYSTEM. 

usually,  be  re-absorbed  under  proper  treatment.  In  other 
cases,  the  result  of  accident  and  occurring  in  persons  whose 
blood  is  in  an  impure  state,  recovery  is  not  so  general,  and 
the  bone  often  begins  to  be  itself  the  seat  of  inflamma- 
tion, and  the  furtlier  symptoms  of  fjreat  tenderness  and 
swelling  over  the  part,  high  fever ,  and  mental  dej^ression 
supervene.  Such  cases  often  end  in  suppuration,  a  deep 
abscess  being  formed,  and  caries  or  necrosis  of  the  bone 
being,  towards  the  end,  developed.  In  all  cases  of  peri- 
ostitis the  treatment  is  surgical  and  directed  to  the  relief 
of  "  tension,"  that  is,  to  the  incision  of  the  swelled  peri- 
osteum ere  it,  or  the  subjacent  bone,  die  from  the  contin- 
uance of  the  pressure  resulting  from  the  effused  lymph. 

Degenerations  of  Bone. 

Rickets  (Osteomalacia  Infantum). — This  well-known  dis- 
ease consists  in  an  excessive  growth  of  the  cartilaginous, 
with  defective  formation  or  sometimes  actual  re-absorp- 
tion of  the  hard  parts,  of  certain  bones,  which  in  conse- 
quence bend,  according  to  the  weight,  traction,  or  pressure 
brought  to  bear  on  them. 

It  is  almost  exclusively  a  disease  of  childhood,  the  sec- 
ond year  of  life  being  the  commonest  time  of  appearance. 

7^he  si/mptoms  are  of  two  kinds:  (a)  Those  of  general 
ill-health:  pallor,  imperfect  digestion,  profuse  perspira- 
tion, especially  of  the  head  at  night,  stunted  growth,  en- 
larged tonsils  and  lymphatic  glands,  (b)  Those  confined 
to  the  bony  changes.  The  head  becomes  large  and  the 
forehead  prominent,  the  openings  of  the  infant's  head 
(the  fontanelles)  closing  slowly.  The  chest  becomes  nar- 
row and  often  pointed  (pigeon-breast).  The  spine  may  be- 
come much  curved,  and  the  bones  of  the  pelvis  distorted. 
The  most  noticeable  feature  is,  however,  the  boioing  of 
the  legs,  which  bend  under  the  weight  of  the  trunk. 


RICKETS.  559 

Not  all  of  these  symptoms  may,  however,  be  present  in 
every  case. 

Causes. — Debility  in  the  parents,  who  may  have  been 
too  young,  delicate,  badly  nourished,  or  intemperate  in 
habits.  Frequent  parturition  in  delicate  women  is  apt  to 
result  in  one  or  more  rickety  children.  The  onset  of 
rickets  is  favored  markedly  by  bad  diet,  by  insufficient 
fresh  air,  and  by  the  strain  of  dentition. 

The  outlook  is  usually  reassuring.  Good  nourishment, 
fresh  air,  and  suitable  clothing  and  care  will  generally 
suffice  to  restore  the  sufferer  to  health.  Some  few  very 
bad  cases  die;  many  retain  throughout  life  marked  traces 
of  their  deformity. 

The  treatment  is  purely  hygienic  and  dietetic.  No 
drug  is  of  any  avail.  The  ridiculous  and  most  mischiev- 
ous recommendation  to  administer  additional  phosphate  of 
lime  to  children  who  cannot  assimilate  the  amount  already 
present  in  their  food,  or  w^hose  bodies  are  absolutely  re- 
absorbing what  lime  has  already  been  deposited  in  their 
bones,  has  fortunately  ceased  to  disgrace  medical  litera- 
ture. 

Osteomalacia,  called  also  "  molUties  ossium "  and  adult 
rickets^  is  a  somewhat  rare  disease,  occurring  most  gener- 
ally in  women  at,  or  about,  the  change  of  life. 

The  symptoms  are  produced  by  a  re-absorption  of  the 
earthy  phosphates  (which  pass  away  in  great  quantities 
in  the  urine)  in  the  bones,  their  structures  consequently 
softening  and  giving  way  under  ordinary  strain  as  in  in- 
fantile rickets. 

It  commences  commonly  in  the  pelvic  bones,  which  sink 
in,  lessening  by  some  inches  the  patient'' s  height ;  then  the 
process  invades  the  spinal  column,  which  also  yields,  fur- 
ther decreasing  the  stature;  lastly,  the  bones  of  the  arms 
and  legs  are  affected,  and  also,  but  to  a  lesser  extent,  those 


560  DISEASES    OF    THE    MOTOR    SYSTEM. 

of  the  head.  All  the  bones  break  very  easily,  no  reunion 
being  procurable.  Generally  these  changes  are  accom- 
panied by  rheumatic  pains  and  by  great  loss  of  strength 
and  fleshy  but  sometimes  the  health  is  but  little  impaired. 
The  disease,  however,  usually  shortens  life  by  many  years. 
The  precise  cause  of  this  malady  is  obscure,  as  also  the 
reason  why  it,  by  preference,  selects  the  female  sex.  The 
treatment,  never  very  successful,  consists  in  attention  to 
the  general  health. 

Osteitis  deformans  is  a  similar  disease  to  the  one  just  de- 
scribed, but  a  rarer  one.  It  is  marked  by  an  absolute  en- 
largement of  certain  bones,  accompanied  by  a  softening 
process  akin  to  that  seen  in  osteomalacia.  Loss  of  height, 
bowing  of  the  legs,  and  marked  enlargement  of  the  head, 
accompanied  often  by  calcareous  degeneration  of  the  arte- 
ries, are  the  symptoms.  There  is  rarely  pain.  This  dis- 
ease is  commoner  in  the  male  than  in  the  female.  Its 
causation  is  unknown,  its  treatment  unsatisfactory. 

Cancerous  and  other  tumors,  abscesses,  etc.,  of  bone  as 
of  other  tissues,  occur,  but  do  not  demand  notice  at  our 
hands. 

With  this  brief  review  we  may  dismiss  the  motor  sys- 
tem,  the  derangements  of  which  the  surgeon  claims  almost 
exclusively  as  his  department.  Strictly  speaking,  this  sys- 
tem is  but  an  integral  part  of  the  food  system,  and,  in  a 
medical  treatise,  deserves  only  on  the  score  of  its  special 
function — locomotion — any  separate  notice. 


No.  4.— xribe  lReprot)uctiv>e  System* 


CHAPTER  XIX. 
DERANGE^IENTS    OF    THE  EEPRODUCTIVE   SYSTEM. 

THE  REPRODUCTITE   SYSTEM. 

Brief  General  Remarks  on  the  Functional  and  Organic  Disorders 

of  this .  System. 
24* 


Ube  IReptobucttpe  System* 


CHAPTER  XIX. 

DERANGEMENTS    OF    THE   REPKODUCTIYE   SYSTEM. 

A  FEW  -words,  more  to  remove  popular  misconception 
concerning  it  than  to  classify  its  disorders,  will  suffice  for 
all  that  is  necessary  to  say,  in  a  popular  work,  about  the 
reproductive  system. 

In  the  first  place,  there  is  a  wide  difference  between  the 
influence  exerted  on  the  whole  body  by  disorders  of  this 
special  system,  in  the  two  sexes  of  mankind. 

In  man  the  sexual  instinct  is,  as  in  all  male  mammals, 
strong,  constituting  in  a  state  of  nature  one  of  the  ruling 
passions  of  life.  This  fact  should  not  be  blinked,  but 
rather  be  openly  admitted,  with  a  view  to  its  judicious 
curbino^  in  accordance  Avith  the  rules  of  reli™n  and  of 
modern  society,  and  which  curbing  can  only  be  effected 
by  a  careful  training  and  cultivation  of  that  control  pow- 
er, that  subordination  of  the  wild  instincts  of  man  to  the 
dictates  of  his  reason — the  decisions  of  the  higher  brain 
centres — the  possession  of  which,  more  than  anything  else, 
marks  civilized  man  off  sharply  from  the  brutes. 

The  healthiest  type  of  brain  is,  then,  that  which  contains 
the  most  efficient  control  power;  the  least  healthy  type 
that  which  is  altogether  wanting  in  this  force,  the  brains 


564       DERANGEMENTS    OF    THE    REPRODUCTIVE    SYSTEM. 

of  those  wlio  arc,  by  common  consent,  removed  from  the 
society  of  men — the  insane  and  the  demented.  But  be- 
tween the  two  extremes  there  are  many  grades. 

An  overmastering  tendency  to  follow  the  instincts  or 
the  inclination  of  the  hour  is  a  strong  characteristic  of  a 
deficient  or  badly  co-ordinated  brain.  Thus,  in  man,  we 
find  an  inherent  tendency  to  sexual  excess,  linked  strongly 
with,  and  often  ending  in,  insanity;  not  that  the  excess 
produces  the  mental  failure,  or  even,  in  many  cases,  con- 
tributes much  to  it,  for  it  ranks  merely  as  a  symptom  of 
the  pre-existing,  underlying  mental  weakness. 

The  sexual  instinct,  then,  being  strong  in  the  male,  it 
follows  that,  in  order  to  avert  the  many  ruinous  conse- 
quences that  ensue  from  its  undue  gratification,  the  best 
way  is  to  seek  early  in  life  to  strengthen  that  barrier, 
which  alone  can  be  relied  on  for  protection,  the  control 
power,  by  the  practice,  in  many  little  things,  of  cheerful 
self-denial.  Above  everything,  youth  should  be  taught 
tlie  great  physiological  fact  that  continence,  even  lifelong 
continence — provided  it  be  a  chastity  both  of  mind  and 
of  body — is  not  only  consistent  with,  but  directly  condu- 
cive to,  the  highest  health  and  the  greatest  success  and 
happiness  in  life,  and  to  view  with  aversion  and  contempt 
those  lying  guides  who — whatever  their  genius  and  liter- 
ary talents — seek  to  propagate  the  false  and  inhuman 
doctrine  that  self-gratification  is  both  manly  and  neces- 
sar3\  It  is  almost  unnecessary  to  add,  that  in  all  families 
in  which  there  is  a  history  of  insanity,  these  precaution- 
ary measures  require  the  greatest  possible  attention. 

Functional  derangements  of  the  organs  of  reproduction 
are  fairly  common  in  the  male,  but  are  almost  always,  at 
least  under  fifty  years  of  age,  secondary  to  some  derange- 
ment of  the  nervous  system.  They  are  never  benefited 
by  tonics.     There  is  no  actual  failure  or  debility  present. 


FUNCTIONAL    DISORDERS    OF    WOMEN".  565 

merely  a  loss  of  co-ordination  of  nervous  power  due  to 
general  nervous  weakness,  and  this  is  to  be  met  by  an 
abundance  of  healthy  out-door  exercise,  of  manly  society, 
and  by  other  measures  calculated  to  bring  again  the  ner- 
vous mechanism  into  trim.  Five  grains  of  bromide  of 
potassium  in  a  little  syrup,  taken  three  times  a  day  for  a 
week  or  two,  will,  in  nearly  every  case,  by  its  steadying 
influence  on  the  nervous  system,  expedite,  or  actually  suf- 
fice to,  a  cure. 

Organic  disorders  of  the  reproductive  organs  are  very 
rare  in  man,  and  when  they  occur  require  surgical  meas- 
ures for  their  relief. 

In  woman,  affairs  as  regards  this  system  stand  on  quite 
a  different  footing. 

In  the  healthy  woman  sexual  passion  counts  for  noth- 
ing, or  for  very  little.  Certainly  it,  alone,  does  not,  as  is 
so  often  the  case  in  man,  constitute  a  ruling  factor  in  the 
course  of  the  life  history.  In  many  healthy  women  it  is, 
indeed,  entirely  absent.  The  craving  for  sympathy,  love, 
adulation,  and,  above  all,  the  strong  instinct  of  maternity, 
replace  it.  When,  in  woman,  powerful  sexual  passion 
really  exists — and  is  not  skilfully  simulated — it  consti- 
tutes always  a  reason  for  suspicion  of  some  mental  failure 
behind  it,  and  at  certain  periods  of  female  life,  notably 
during  and  just  after  parturition  and  at  the  change  of 
life,  erotic  fancies  and  imaginings  are  almost  always  sy- 
nonymous with  commencing  insanity.  Merely  changing 
the  sex,  we  may  then,  in  regard  to  women,  adapt  the  epi- 
grammatic saying  of  Larochefoucauld,  "  Une  sotte  n'a  pas 
assez  d'etoffe  pour  etre  bonne." 

On  the  other  hand,  from  the  size  and  number  of  organs 
concerned  in  parturition,  a  long  list  of  functional  and 
organic  diseases  peculiar  to  women  exist. 

Of  these,  however,  the  functional  disorders — in  which 


566       DERANGEMENTS    OF    THE    RErROPUCTIYE    SYSTEM. 

class  wc  may  include  nearly  all  misplacements,  conges- 
tions, and  ulcerations  of  the  womb — perhaps  ninety  per 
cent,  of  the  special  female  derangements — are  not  local 
maladies,  to  be  attacked  by  instruments,  replacers,  sup- 
ports, caustics,  etc.,  but  merely  localized  indications  of 
some  general  bodily  failure,  usually  a  general  muscular 
atony,  so  common  in  the  female  sex,  or  a  general  nervous 
debility,  or  more  rarely  they  are  of  scrofulous  origin,  but 
in  any  case  only  to  be  cured  by  means  directed  to  the  im- 
provement of  the  general  muscular  and  nervous  tone. 
The  application  of  these  measures  must,  of  course,  be  con- 
ducted with  skill  and  care.  It  will  not  do  to  tell  a  sufferer 
from  incessant  "  bearing-down  "  to  get  up  and  take  long 
walks  or  to  indulge  in  violent  horse  exercise.  A  course  of 
massage,  by  improving  muscular  power  and  restoring  the 
digestive  powers,  will  often  be  the  first  step,  from  which 
an  advance  may  be  made  by  a  visit  to  some  bracing  health 
resort,  to  be  followed  perhaps  by  a  sea  voyage.  The 
reader  will  say  that  such  measures  are  beyond  the  means 
of  poor  sufferers,  but,  as  a  matter  of  fact,  the  sufferers  are 
but  rarely  poor;  the  woman  who  has  to  earn  her  daily 
bread  rarely  can  find  time  for  such  a  luxury  as  a  functional 
womb  derangement,  which  is  often  as  much  the  product 
of  an  ardent  imagination,  an  enthusiastic  specialist,  and  a 
desire  for  sympathy  and  leisure,  as  of  a  real  lesion. 

The  organic  diseases  of  the  reproductive  system  of 
women  are  very  grave  and  real  disorders,  but  there  is 
nothing  special  about  them,  nothing  that  entitles  them  to 
rank  in  medicine  as  mysterious  disorders,  and  nothing  that 
necessitates  their  being  handed  over  to  a  special  sui:geon, 
for  surgical  means  are,  when  any  treatment  is  likely  to 
avail,  the  only  ones  that  can,  with  hopefulness,  be  had  re- 
course to. 


SUMMARY.  567 

To  sum  lip.  The  functional  disorders,  the  incompe- 
tencies, of  the  male  sex  are  almost  invariably  the  sequence 
of  a  want  of  co-ordinating  power,  the  result  of  some  dis- 
turbing factor  in  the  general  nervous  system,  and  are, 
without  almost  any  exception,  curable  by  means  calculated 
to  improve  the  general  health  and  to  restore  that  confi- 
dence in  self  which  often  is  the  sole  factor  at  work  in  the 
disorder.  Those  that  affect  the  female  sex  are  more  nu- 
merous, and  due  not  entirely,  though  also  often,  to  nervous 
debility,  but  generally  dependent  on  a  loss  of  the  general 
muscular  power  or  on  some  failure  of  the  general  health, 
the  result  of  scrofula,  want  of  blood,  imj^erfect  digestion 
of  food,  lack  of  exercise,  to  which  may  often  be  added  a 
morbid  concentration  of  the  mind  on  one  portion  of  the 
body,  a  state  directly  conducive  to  local  congestion. 
They  are  to  be  met  by  the  resolute  adoption  of  means 
calculated  to  improve  health  and  tone  and  to  infuse  fresh 
interest  into  life. 

The  organic  diseases  of  both  sexes  present  no  features 
which  differentiate  them  in  any  very  special  manner  from 
similar  diseases  and  degenerations  attacking  other  parts 
of  the  body,  and  are  to  be  treated  on  surgical  lines. 


APPENDICES. 


I.  FORMULA. 

II.  HINTS   ON  DIET. 

III.  ARRANGEMENT   OF   THE   SICK-ROOM. 


APPENDIX  No.  I. 


FORMULAE. 

1,  As  a  Simple  StomacMc  and  Mild  Purgative. 

Trisnitrate  of  Bismutli 10  grains. 

Bicarbonate  of  Sodium    .......  5  grains. 

Powdered  Rliubarb 5  to  10  grains. 

Oil  of  Spearmint 1  drop. 

To  be  made  into  the  form  of  a  powder,  and  to  be  taken  in  water, 
at  bedtime,  once  or  twice  a  week. 

2.  For  the  Reduction  of  Corpulency. 

Iodide  of  Potassium 1  drachm. 

Carawaj-seed  Water  .     .    .     ....     .    6  ounces. 

Mix.    Take  one  tablespoonful,  in  water,  on  an  empty  stomacli, 
twice  a  day  for  a  month  or  more. 

3.  For  the  Reduction  of  Corpulency. 

Iodide  of  Sodium 1  drachm. 

Caraway-seed  Water -6  ounces. 

Dose.    As  before. 

4.  For  the  Expulsion  of  Tape-worm. 

A  full  dose  of  Castor  Oil  overnight,  to  be  followed  in  the  morning, 
two  hours  before  breakfast,  by  the  following  mixture : 

Extract  of  Male  Fern 80  drops. 

Syrup  of  Ginger |-  an  ounce. 

Mucilage  of  Tragacanth .  2  ounces. 

Water,  up  to      ......     .     .     .     .  4  ounces. 

If  there  be  any  doubt  as  to  the  expulsion  of  the  entire  worm,  it  is 
well  to  repeat  the  above  process  once  or  twice,  at  intervals  of  a  week. 


572  APPENDIX. 

5.  A  Useful  Alterative. 

Iodide  of  Sodium 1  drachm. 

Tartrate  of  Iron 1  drachm. 

Distilled  Water 6  ounces. 

Mix.     One  tablespoonful,  in  water,  on  an  empty  stomach,  twice 
or  thrice  daily. 

6,  To  Soothe  the  Stomach  in  Chronic  Gastric  Derangement. 

Trisnitrate  of  Bismuth 1  ounce. 

Heavy  Carbonate  of  Magnesium   ....     ^  an  ounce. 

Mix  the  two  powders  together. 

A  teaspoonful  in  fresh  soda  water  to  be  taken  early  in  the  morn- 
ing and  late  at  night. 

7^  8,  9.  Useful  Aperients. 

Powdered  Rhubarb  Root     ......  2  drachms. 

Trisnitrate  of  Bi-smuth     ......  2  drachms. 

Heavy  Carbonate  of  Magnesium   ....  3  drachms. 

Powdered  Ginger 1  drachm. 

Mix  into  a  powder. 

One  eighth  part  at  bedtime  when  the  stomach  is  disordered. 

Castor  Oil ^  an  ounce. 

Bicarbonate  of  Sodium 15  grains. 

Peppermint  Water,  to 4  ounces. 

Mix.    This  makes  a  purgative  draught  for  an  adult.     The  taste  of 
the  oil  is  well  masked  by  this  simple  combination. 

Or,  Castor  Oil ^  an  ounce. 

Mucilage ^  an  ounce. 

Syrup  of  Ginger ^  an  ounce. 

Cinnamon  Water,  to 4  ounces. 

Mix.     Same  directions. 

10.  Castor-Oil  Mixture  for  Diarrhcea. 

Castor  Oil ^  an  ounce. 

Glycerine ^  an  ounce. 

Spirits  of  Cajuput ^  an  ounce. 

Mix.     Take  a  large  teaspoonful  in  a  wineglass  of  thick  barley 
water  twice  a  day. 


FORMULA.  573 

11,  Salicylic- Acid  Treatment  of  Gall  Stone,  Oall  Sand,  or  Gall  Gravel. 

Salicylic  Acid 10  grains. 

Powdered  Ginger 10  grains. 

Sulphate  of  Potassium •.     20  grains. 

Phosphate  of  Sodium 20  grains. 

Mix.  One  of  such  powders  to  be  dissolved  in  a  tumbler  of  hot 
water,  and  to  be  slowly  drunk  each  morning  before  breakfast. 

12^  13^  14.  Stimulating  Hepatic  Purges  in  tJie  Earlier  Stages  of  Fever. 

Salicylate  of  Sodium 20  grains. 

Powdered  Rhubarb 5  grains. 

Compound  Liquorice  Powder 30  grains. 

Oil  of  Cajuput 1  drop. 

Mix.  Such  a  powder  may  sometimes  with  advantage  be  taken 
twice  a  day,  by  an  adult,  during  the  first  two  or  three  days  of  any 
acute  fever. 

Or,  Each  evening,  for  two  or  three  successive  days,  a  powder  con- 
sisting of  3  grains  of  Calomel 

may  be  placed  on  the  tongue,  and  followed  in  the  morning,  by  a 
small  teaspoonful  of  effervescent  Citrate  of  Caffein.  The  calomel, 
minus  the  caffein,  in  the  case  of  children. 

Or,  Flexible  Cascara  and  Euonymin  Capsules  (prepared  by  Dun- 
can &  Flockhart,  Princes  Street,  Edinburgh),  one  each  evening,  for 
three  or  four  nights  in  succession. 

15.  In  the  Incubation  Stage  of  Fevers. 

Sulpho-carbolate  of  Sodium 10  grains. 

Such  a  powder  to  be  taken,  dissolved  in  a  tumbler  of  hot  water, 
twice  each  day,  for  five  or  six  days. 

I65  17,  IS.  Ferruginous  Tonics  in  Chlorosis  and  the  Ancemia  of 
persons  under  forty  years  of  age. 

Tincture  of  Steel 2  drachms. 

Chloride  of  Ammonium 2  drachms. 

Glycerine 1  ounce. 

Oil  of  Lemon 8  drops. 

Water,  to 2  ounces. 

Mix.  Dose  one  teaspoonful  in  a  tumbler  of  water  thrice  daily, 
after  eatiuii. 


514:  APPENDIX. 

Citrate  of  Potassium 1  drachm. 

Tincture  of  Steel 64  minims. 

Syrup  of  Lemon .     .  1^  ounce. 

Water,  to  . .     .  2  ounces. 

Mix.  One  teaspoonful  in  a  wineglassful  of  water  thrice  daily. 
A  useful  and  agreeable  mixture  for  ladies  and  children. 

Sulphate  of  Iron 2^  grains. 

Carbonate  of  Potassium Ij  grain. 

Sugar 1  grain. 

Tragacanth  Powder g^  of  a  grain. 

Sixty  of  such  pills  to  be  made.  Two  to  be  taken  three  times  a 
day  for  a  month  or  six  weeks. 

This  last  formula  is  an  improvement  on  the  celebrated  Bland's 
pill. 

W.B.  Other  Foi'mulce  are  to  he  found  in  the  text  under  tJie  diseases 
for  which  they  are  intended  as  medicinal  agents. 


APPENDIX   No.  11. 


HINTS   ON   DIET. 

{a)  Diet  in  Health. 

Both  in  health  and  in  sickness  the  appetite  and  the  inclination 
form  the  best  general  guides  to  a  wise  dietary,  provided  that  the 
hody  be  not  under  the  dominance  of  evil  habit. 

Hunger  and  thirst,  like  the  symptoms  of  disease,  arc  but  expres- 
sions, appealing  to  us  through  our  senses  by  different  channels,  of 
that  effort  which  the  body  of  man,  like  every  other  substance  ani- 
mate and  inanimate,  is,  in  obedience  to  a  universal  physical  law, 
compelled  to  make  to  maintain  an  equilibrium,  a  condition  of  bal- 
ance—which in  the  human  body  means  health — with  its  surround- 
ings. 

In  every  condition  of  health  and  of  sickness  there  is  this  natural 
tendency  to  balance,  to  health,  or  to  the  nearest  approach  thereto. 

We  might  therefore,  it  would  seem,  really  leave  everything  to 
Nature.  This,  however,  is  not  so;  for  in  man,  not  the  temporary 
restoration  and  maintenance  of  health,  that  for  which  Nature  alone 
provides;  but  prolongation  of  life — a  providing  for  a  long  lease  of 
life — is  tiie  great  desire  of  man  and  the  great  aim  of  medicine. 

"We  see,  in  the  victim  of  ill-habit,  the  great  contrast  existing  be- 
tween these  efforts  of  Nature  on  the  one  hand  and  the  desire  of  the 
human  mind  on  the  other. 

Thus  the  body  of  the  habitual  drunkard  and  the  gourmand  de- 
mands abundance  of  alcohol  or  a  large  excess  of  stimulating  food; 
Nature  makes  this  strange  demand,  and  Nature  is  acting  in  strict 
accord  with  her  laws.  Under  the  altered  conditions  which  these 
self -indul gents  have  effected  in  their  bodies  stimulants  have  become 
necessary  for  the  maintenance  of  temporary  health;  ordinary  plain 
food  can  no  longer  be  digested  by  them,  the  stomach  requires  a 


576  HINTS    ox    DIET. 

stronger  stimulus  than  this  can  supplj^  to  the  pouring  out  of  diges- 
tive fluid;  and  the  nervous  system,  accustomed  also  to  an  artificial 
life,  demands  its  quota  of  alcohol.  But  how  disastrous  is  this  course 
if  a  long,  healthy  life  be  desired!  The  wise  man,  in  this  case,  must 
disregard  Nature,  for  his  aims  and  hers  are  different.  Nature  takes 
no  account  of  the  desires  of  man,  but  concerns  herself  solely  in  the 
meting  out  to  all  matter,  living  or  lifeless,  of  an  equal  and  universal 
law. 

"Fix  upon  that  course  of  life  which  is  best,  custom  will  render  it 
the  most  delightful,"  is  therefore  a  good  motto,  provided  that  the 
decision  as  to  what  is  best  is  arrived  at  after  a  mature  consideration 
of  every  side  of  the  question. 

For  habit,  in  diet  as  in  all  else,  allows  mankind  a  latitude;  and,  I 
might  almost  add,  enjoins  him  to  take  advantage  of  it.  It  has 
enabled  him,  without  decrease  of  days  or  loss  of  health,  to  change 
from  the  gross,  occasional  repasts  of  the  savage  man  to  the  re- 
stricted and  regular  dietary  of  to-day;  and  it  permits  him — in  ex- 
ceptional circumstances  commands  him — to  avail  himself  of  food 
and  of  drink  more  stimulating  and  more  varied  than  that  which  his 
ancestors  enjoj'^ed. 

Thus  it  comes  about  that,  provided  we  exercise  our  reason  in 
the  direction  of  avoiding  gross  and  injurious  excess  of  food,  or  food 
and  drink  of  an  obviously  over-stimulating  nature,  we  may  in  health 
rely  on  our  instincts  to  guide  us  to  a  correct  dietary — satisfaction, 
not  gratification,  marking  the  limit  in  amount. 

The  following  facts  are  furthermore  to  be  kept  in  mind. 

At  no  time  of  life  is  mere  fatness  to  be  viewed  as  a  dietetic  suc- 
cess. It  indicates  rather  the  reverse:  an  excess  of  fuel-foods  (fats 
and  starches)  and  a  deficiency,  at  least  a  deficient  assimilation,  of 
nitrogenous  food.  Experienced  nurses  look  with  suspicion  upon  a 
very  fat  baby,  and  the  insurance  offices  regard  askance  their  too 
corpulent  seniors.  Children  brought  up  at  the  breast,  or  judiciously 
fed  with  some  milky  substitute  for  it,  arc  often  much  less  in  weight 
than  those  fed  on  baby  foods,  rich  in  starch  and  sugar,  but  they  pos- 
sess more  stamina  and  pass  the  perils  of  childhood  more  safely. 

From  the  time  that  the  child  commences  to  feed  itself  it  should 
be  taught  the  dietetic  lesson  of  life:  to  relish  and  depend  on  simple 
food  and  to  take  meals  regularly.  Then,  practically,  the  only  limit 
to  its  meals  need  be  its  natural  desire  to  stop,  for,  up  to  the  time 
that  the  body  ceases  growing,  it  is  scarcely  wise  to  place  restrictions 


DIET   IN    SICKNESS.  577 

on  a  wholesome  appetite.  Milk,  all  the  farinacea,  nearly  all  fruits, 
certainly  all  fresh  ones,  and  vegetables  may  be  allowed  without 
stint.  Up  to  twelve  years  of  age  meat,  a  stimulating  food,  should 
not  be  given  more  than  once  a  day,  but  fish  may  be  allowed  in  more 
liberal  portions.  Sweets  and  confections  are,  except  in  small  quan- 
tities and  at  meal-times,  bad  ;  they  excite  a  spurious  appetite  and 
reduce  the  demands  of  the  stomach  for  the  simpler,  better,  safer 
foods.  In  later  life,  early  gratification  of  the  palate  bears  in  many 
ways  evil  fruit. 

For  the  vigorous  middle  period  of  healthy  life  there  are  no  set 
rules.  A  man's  reason  and  experience  will,  in  a  well-ordered  mind, 
be  an  effective  guide,  while  no  mere  dietetic  restrictions  will  then 
suffice  to  check  the  individual  bent  on  self- gratification. 

In  old  age,  abstinence  is  the  golden  rule.  History  is  almost  unani- 
mous in  its  decision  that  long-livers  have  been  remarkable  for  ab- 
stemiousness. I  mention  this,  inasmuch  as  it  is  not  uncommon  to 
hear  contrary  directions  given  to  the  aged  by  their  sympathizing 
friends.  Fruits  and  vegetables  may  be  freely  allowed  at  this  period, 
as  also  may  fuel-foods,  farinaceous  preparations,  and  all  fats.  In- 
deed, in  many  of  the  debilities  of  the  aged,  especially  in  one  invet- 
erate form  of  mental  depression,  fats,  such  as  cod-liver  oil,  pancreatic 
emulsion,  cream,  etc.,  will  effect  much  good;  but  meat,  fish,  and 
other  highly  nitrogenous  foods  must  be  partaken  of  sparingly.  The 
necessity  for  these  latter  decreases  with  age,  and  the  oxidation  and 
final  expulsion  of  the  products  of  oxidation  of  overmuch  albuminous 
food  tax  the  vital  powers  of  the  aged  unduly. 

(b)  Diet  in  Sickness. 

First  of  all,  I  must  remind  my  readers  that  the  name  of  any  given 
disease  does  not  represent  always  the  same  thing.  The  saying  of 
Hobbes  that  "  words  are  the  counters  of  wise  men,  but  thp  money 
of  fools,"  applies  strongly  to  the  nomenclature  of  states  of  ill-health. 
We,  for  convenience,  group  together  a  number  of  pathological  items, 
or  of  symptoms  which  we  have  found  often  to  occur  together,  and 
dub  the  group  with  a  generic  name,  but  it  must  never  for  a  moment 
be  forgotten  that  the  causes  of  the  phenomena  witnessed,  however 
similar  may  be  these  latter,  are  often  in  different  cases  widely  diver- 
gent, and  that  the  treatment  must  vary  as  the  causes.  Thus  dys- 
pepsia, gout,  and  rheumatism  may  all  be  the  product  of  an  excess 
or  of  a  deficiency  of  food,  and  the  latter  disease  again  may  have  as 
25 


578  HINTS    ox    DIET. 

one  of  its  proximate  causes  a  deficiency  of  exercise  or  an  excess 
thereof.  A  bottle  of  champagne  I  have  known,  even  in  the  same 
individual,  at  an  interval  of  a  few  months  only,  the  first  time  to  cause, 
and  the  second  time  to  speedily  cure,  an  acute  attack  of  gout  in  the 
foot.  Indeed,  if  we  except  the  fevers,  almost  any  disease  may 
spring  from  opposite  causes,  in  the  one  individual,  and  require 
at  each  time  opposite  treatment.  For  these  reasons  it  behooves 
us  to  be  extremely  chary  in  our  recommendation  for  special  diet- 
aries. The  fevers,  however,  form  an  exception  to  this  rule,  for  we 
know  that  in  all  of  them  an  abnormally  rapid  process  of  oxidation 
advances  in  the  body,  the  stores  of  food  in  the  blood  (albumen),  in 
the  liver  (animal  starch),  and  in  the  loose  cellular  tissues  (fat),  being 
speedily  used  up,  and  that,  concurrently,  all  the  processes  of  diges- 
tion, including  those  usually  spoken  of  as  assimilation,  come  nearly 
or  completely,  according  to  the  severity  of  the  fever,  to  a  standstill. 
We  may  therefore  safely  generalize  concerning  them  as  follows. 

Diet  in  Fever. 

In  fevers,  as  in  all  disease,  it  behooves  us  to  follow  our  instincts 
and  not  the  dietetic  rules  of  the  books,  which  are  based,  necessarily, 
on  an  imperfect  knowledge  of  the  human  bod}^  Nature  does  not 
resign  her  supremacy  in  disease  and  give  place  to  some  diabolical 
agent  who  seeks  ever  to  mislead,  through  the  sensations,  the  un- 
fortunate sufferer.  We  have  seen  that  evil  habit  may,  in  health, 
throw  the  seeker  after  a  long,  well-balanced  life  sometimes  off  the 
scent,  but  this  disturbing  factor  operates  with  but  little  force  in  fever, 
and  we  are  only  too  glad  to  avail  ourselves,  in  such  a  desperate  state 
of  matters,  of  the  time-serving  policy  of  the  maintenance,  at  all  risks 
as  to  the  future,  of  that  temporary  balance  for  which  Nature  ever 
works  within  us.  We  shall  then  do  well  to  regulate  our  fever 
dietary  by  the  demands  of  the  body,  and  I  may  add  that,  as  far  as 
my  experience  goes,  such  a  course  is  more  successful  than  any  other 
in  the  treatment  of  this  class  of  disorder. 

In  mild  fever  of  any  kind,  when  the  temperature  is  below  101°  F., 
there  will  usually  remain  some  desire  for  solid  food,  for  something 
a  little  tasty,  but  in  small  quantity.  Let  this  desire  be  gratified. 
It  is  one  which  we  should  expect  to  find  present.  The  stomach, 
not  yet  crippled,  wants  a  little  whipping  up,  that  it  may  do  its 
work;  let  the  moderate  stimulus  that  is  necessary  be  forthcoming: 
ripe  but  slightly  acid  fruit,  jellies  flavored  to  taste,  small  quanti- 


DIET   IN    GOUT,  DYSPEPSIA,  AND    BILIOUSNESS.         579 

ties  of  well-made  farinaceous  puddings,  thin,  light  soups.  Should 
there  be  a  demand  for  anything  more  substantial,  it  may  be  sup- 
plied, for  the  digestive  capacity  is  not  equally  feeble  in  all  cases 
marked  by  an  equal  rise  of  temperature.  Acidulated  and  cold 
drinks  are  often  called  for,  and  may  be  given  without  stint.  Sugar 
and  fats  are  usually  loathed,  and,  if  forced  upon  the  sufferer,  rarely 
fail  to  produce  obvious  signs  of  discomfort. 

In  cases  of  fever  marked  by  a  higher  temperature,  it  is  well  to 
follow  the  same  general  rule.  As  the  fever  rises  the  call  for  solids 
will  vanish,  but  that  for  thin,  light  liquids  will  increase.  Whey, 
plain  or  acidulated  water,  fresh  fruits  (if  demanded),  and  light  fish 
or  meat  broths  (unthickened)  may  be  given.  Milk  is  not  in  these 
cases  well  digested,  the  curd  which  in  health  as  in  disease  forms  in 
the  stomach  is  generally  in  fever  beyond  the  digestive  capacities 
and  sets  up  irritation;  but  there  are  exceptions,  and  if  there  be  a 
desire  for  milk,  it  need  not  be  withheld.  Tea  and  coffee  are  often 
refreshing  to  the  sufferer.  Alcohol  may  have  to  be  administered, 
usually  rather  as  a  medicine  than  a  food;  a  wineglassful  of  white 
Burgundy  or  of  Rhenish  wine,  in  half  a  tumbler  of  aerated  water,  is 
usually  relished  by  the  patient,  and  given  at  intervals  of  four  to  six 
hours  is  amply  sufficient.  It  is  of  no  use  attempting  to  force  the 
hand  of  Nature  by  administering  large  and  oft-repeated  doses  of 
alcohol,  unless,  of  course,  the  object  be  to  tide  over  merely  a  few 
hours  of  the  gravest  danger,  a  crisis,  after  which  we  may  naturally 
expect  a  subsidence  of  the  fever. 

Diet  in  Chronic  Gout,  Dyspepsia,  and  Biliousness. 

These  disorders  are  not  generally  marked  by  any  rise  of  tem- 
perature, and  it  is  only  to  such  cases  I  refer,  for  if  fever  be  present 
they  must  be  treated,  according  to  the  temperature  present,  on  the 
lines  just  laid  down.  Habit  and  prejudice  often  mislead  in  these, 
as  in  all  non-febrile  attacks.  The  victims  are  often  immoderate 
eaters  and  drinkers — immoderate  in  relation  to  their  special  indi- 
vidual requirements — and  behind  the  functional  disturbance  which 
prompts  care,  the  voice  of  the  stomach  is  still  heard  calling  for  its 
accustomed  excess. 

The  reason  and  will  of  the  sufferer  must  here  be  invoked  to  our 
aid.  His  digestive  apparatus  has  broken  down;  that  is  a  fact  he 
cannot  get  over,  and  a  period  of  self-denial,  marked  perhaps  by 
many  uncomfortable  symptoms,  must  be  faced.    Free  purgation  and 


380  HINTS    ON    DIET. 

the  administration  of  depressing  remedies  will  have  the  same  effect 
and  is  the  course  of  treatment  often  adopted,  but  it  is  a  bad  one. 
The  sufferer  Jias  to  ask  himself  what  are  the  special  limits  within 
which  he  can  indulge  his  appetite  and  thirst;  not  to  judge  by  his 
neighbors'  capacities.  To  these  limits  he  must  restrict  himself  in 
the  future,  or  take  the  consequences.  If  an  inveterate  sinner,  or  if 
he  be  very  old  or  feeble,  it  may  well  happen  that  these  limits  fall 
without  the  line  of  safe  restrictions;  then  the  dietary  must  be  as 
near  the  line  as  is  consistent  with  health,  for  though  an  occasional 
breakdown  may  be  inevitable,  yet  the  interval  between  each  failure 
will  be  prolonged. 

Diet  in  Scrofula  and  in  the  early  stages  of  Consumption. 

The  diet  in  scrofulous  states  should  be  a  full  one,  and  may  with 
advantage  be  rich  in  fats.  It  is,  however,  of  no  use  to  endeavor  to 
feed  up  on  those  lines  unless  the  body  be  first  strengthened  so  as  to 
be  able  to  avail  itself  of  that  which  passes  down  the  gullet.  I  have 
heard  scores  of  mothers  lament  that  their  sickly  little  ones  loathed 
that  which  the  doctor  had  so  strongly  recommended — cod-liver  oil, 
cocoa,  etc.  Precisely,  and  the  child  is  right.  Remove  the  sickly 
one  to  an  air  rich  in  ozone,  to  a  dry,  bracing  climate,  and  let  it  have 
an  abundance  of  exercise  and  play;  in  other  words,  make  room  for 
the  fuller  diet,  supply  oxygen  to  use  it,  enjoin  exercise  to  remove 
waste  products  accumulated  in  the  tissues  that  check  further  ab- 
sorption, and  in  nine  cases  out  of  ten  the  mother  may  throw  away 
the  cod-liver  oil,  for  the  child's  appetite  for  all  foods,  including  even 
the  fats,  will  be  brisk,  and  it  will,  moreover,  be  evident  that  the 
foods  now  find  their  real  billets  in  the  body.  You  must  consider  not 
only  your  food  but  the  capacities  of  your  sufferer,  and  if  you  expect 
success  the  two  powers  must  be  equalized.  It  is  true  that  cod-liver 
oil,  being  an  easily  assimilated  fat,  will  sometimes  slip  into  the  body 
when  other  fats  will  not,  and  will  thus  in  appearance,  even  without 
change  of  air,  fatten  and  improve  the  patient;  but  all  practical  phy- 
sicians know  that  the  fat  resulting  from  it  is  not  "  thrifty,"  vanishing 
rapidly  on  the  least  derangement  of  the  general  health.  It  is  thus 
but  a  stop-gap,  and  an  indifferent  one,  in  scrofulous  and  consump- 
tive states. 

In  the  stages  of  consumption  marked  by  fever  it  is  of  no  use  at- 
tempting to  feed  up;  the  patient's  inclinations  may  be  followed, 
for  as  much  food  will  be  asked  for  as  is  required. 


DIET    IX    DIABETES    AXD    CONSTIPATION.  581 

Diet  in  Diabetes. 

I  shall  not  attempt  to  supply  the  ordinary  list — a  long  one — of  foods 
suitable  and  unsuitable  in  this  disease.  Such  directions  may  be 
obtained,  gratis,  of  any  vendor  of  diabetic  specialties.  The}'  should 
be  closely  followed  in  all  cases  in  which  a  first-class  physician  has 
pronounced  the  disease  to  be  real  diabetes.  I  am  compelled  to  say 
this,  for  a  vast  number  of  people  subject  to  glucosuria,  the  mere 
result  of  some  temporary  hepatic  disorder,  and  many  aged  persons 
who,  as  a  result  of  the  calcification  of  the  arteries  natural  to  old 
age,  pass  by  the  urine  quantities  of  sugar,  are,  on  very  insufficient 
grounds,  put  on  a  strict  diabetic  regime,  only  to  become  infinitely 
worse  by  such  an  unwise  and  unscientific  course. 

Diet  in  Constipation. 

To  overcome  constipation  by  food  it  is  necessary  to  consume 
articles  that  contain  much  material  that  is  incapable  of  diges- 
tion and  absorption,  such  material  being  naturally  expelled  the 
body,  thus  relieving  the  constipation.  Ripe  fruit  eaten  with  the 
skin  (in  cases  in  which  the  skin  is  edible),  as  well  as  figs,  oranges, 
and  dates,  which  contain  much  that  is  useless  in  the  strict  food 
sense,  are  useful  in  constipation.  Poriidges  and  brown  bread  are, 
for  the  same  reason,  to  be  recommended. 

People  who  live  largely  on  concentrated  foods,  such  as  meat,  flsh, 
potatoes,  white  bread,  and  farinaceous  puddings,  must  expect  to  be 
constipated,  for  nearly  the  whole  of  such  food  is  capable  of  absorp- 
tion. It  does  not  follow,  of  course,  that  in  their  cases  a  small 
amount  of  constipation  is  always  an  evil,  but  a  certain  amount  of 
intestinal  activity  is  necessar}^  inasmuch  as  it  subserves  other  pur- 
poses besides  the  onward  movement  and  expulsion  of  waste  actually 
lying  in  the  bowel. 

These  brief  hints  on  diet  will  suffice.  To  the  healthy  layman 
they  may  seem  too  short  and  general  to  be  of  use,  but  the  chronic 
invalid  who  has  really  tried  treatment  by  rigid  dietetics,  as  laid 
down  by  the  books  and  so-called  specialists  in  diet,  will  agree  with 
me  in  thinking  that  I  have  said  enough.  Every  man's  body  and 
every  man's  diet  are  different,  and  the  endeavor  to  force  all  man- 
kind, or  even  all  sick  mankind,  into  one  of  six  or  seven  groups, 
fails  always  in  practice,  however  satisfactory  it  may  appear  in  the 
pages  of  a  book. 


APPENDIX  No,  III. 


ARRANGEMENT  OF  THE  SICK-ROOM. 

A  iiooM  of  tolerable  dimensions  and  free  as  possible  from  all  the 
noises  of  the  house  and  the  street  should  be  selected.  By  prefer- 
ence it  should  have  a  southern  exposure. 

Ventilation  should  be  attended  to.  When  a  fire  is  necessary,  the 
fireplace  and  chimney  will  act  as  an  efficient  ventilator  and  purifier 
of  the  atmosphere,  but  in  summer-time  other  means,  selected  accord- 
ing to  the  needs  of  the  case,  must  be  adopted. 

The  nurse  or  other  regular  attendant  should  be  cheerful  and 
quiet,  and  possessed  of  sufficient  tact  and  knowledge  to  keep  the 
patient  comfortable  without  being  fussy. 

All  preparation  of  food  should  be  undertaken  away  from  the  sick- 
room. 

The  bed  should,  if  possible,  be  of  such  construction  as  to  permit 
of  the  free  circulation  around  it  and  under  it  of  the  air  of  the  room. 

A  spring  bed  or  a  horse-hair  mattress,  and  not  a  feather  bed, 
should  be  selected.  Unless  there  be  some  very  special  reason  to  the 
contrary,  the  coverings  of  the  bed  in  all  febrile  and  inflammatory 
disorders  should  be  light,  and  if  the  patient  complains  of  great  heat, 
be  even  further  lightened. 

In  fine,  everything  should  be  done  to  promote  the  patient's  com- 
fort, to  assist  his  body  in  the  recovery  process,  and  to  stimulate  his 
mind  by  hope. 


INDEX. 


Abscess  of  brain,  534. 

lung,  469,  476. 

muscle,  556. 

scrofulous,  or  cold,  412. 

tonsil,  see  Quinsy. 
Acidity,  157. 
Acne,  common  form,  426,  431. 

consequence  of  kidney  failure, 
436. 

lymphatic  disorder,  436. 

rosacea,  425,  426. 
Addison's  disease,  392,  393. 
Adenia,  392. 
Aggregates  of  forces,  21-23,  38, 

55^ 
Ague,  363-365. 

causes  enlargement  of  liver  and 
spleen,  365. 
Air,  humidity,  purity,  and  tem- 
perature of,  72-75. 

currents  or  winds,  78,  79. 
Albumen,  59,  63,  130. 

digestion  of,  132. 

effects  of  excess  of,  178. 

normal  supply  for  bodily  needs, 
60,  61,  149,  150. 

serum,  178. 
Albuminuria,  448. 

due  sometimes  to  liver  disor- 
der, 305. 
Alcohol,  250-258. 

effects  on  urea  of,  255,  256. 

general  effects  on  body  of,  251, 

Germain  See  on,  255,  256. 
increases  "weight,  252. 
is  it  a  food?  251. 
its  place  as  an  indirect  nutri- 
ent, 251,  252. 


legitimate  uses  of,  253,  254. 

misuses  of,  in  institutions,  254, 
255. 

rules  for  consumption  of,  257. 

utility  in  fevers,  254. 
Alcoholic  intoxication,  506. 
Anaemia,  a  cause  of  ' '  heart  mur- 
murs," 331,  332. 

of  brain,  147,  534. 
Aneurism,  335. 
Angina  pectoris,  327,  328. 
Animal  heat,  source  of,  13. 
Aortic    orifice,   contractions   of, 
321. 

valves,  incompetency  of,  322. 
Aperients,  some  useful,  572. 
Apoplexy,  165,  335,  532,  533. 

causes  and  treatment,  532,  533. 

serous  form  of,  537. 
Armstrong,  Sir  W.,  on  man  and 

the  steam-engine,  14. 
Arrangement  of  sick-room,  582. 
Artificial  digestive  agents,  70,  71. 
Assimilation  of  foods  arrested  in 

fevers,  64,  65,  69,  376,  578. 
Asthma,  476-482. 

amyl  nitrite  in,  480,  481. 

causation   and    symptoms    of, 
476,  477. 

due  sometimes  to  teething,  478. 

forced  breathing  in,  481,  482. 

treatment  of,  479-482. 

varieties  of,  478,  479. 
Athetosis,  413. 

Auber,  quotations  from,  37,  53. 
Aura  epileptica,  513,  514. 

Bacilli,  see  Bacteria. 
Bacteria,  27,  72,  73,  230  et  seq. 


584 


INDEX. 


Bacteria,  as  blood  poisons,  344. 

causes  of  fever  symptoms,  346. 

development  of  abnormal  kinds 
of,  230-235,  345,  346. 

functions  of  the  ordinar}'^  kinds 
of,  73. 

how  they  travel,  234. 

in  milk  and  water,  234. 

natural  inhabitants  of  the  air, 
73. 

to  destroy,  236. 

ubiquitous,  73,  230. 
Banting  system  in  obesit}-,  207. 
Beer,  narcotic  properties  of,  258. 
Bile,  the,  169,  170. 
Biliousness,  169-177,  300. 

acute  attack  of,  170. 

causation  of,  170. 

chronic,  171. 

diagnosis  of,  176. 

lung  affections  in,  195. 

skin  affections  in,  191-193. 

treatment  of,  171-173. 
Bismuth,  trisnitrate  of,  159,  572. 
Bites  of  rabid  animals,  see  Hydro- 
phobia. 
Black  death,  357. 
Blood,  the,  simply  liquid   food, 
339. 

solid  and  liquid  parts  of,  339. 
Blood  disorders,  340-391. 
Blood    poisons,    living    (germs), 
230,  344. 

mineral  and  vegetable,  340-342. 
Blood  spitting,  483,  484. 

causes  of,  484. 
Blood-vessels,   diseases  of,   332- 

335. 
Blue  disease,  324. 
Boils,  431. 

caused  sometimes  by   kidney 
failure,  436. 
Bones  of  the  body,  as  levers,  553. 

functional  disorders  of.  556. 

organic  disorders  of,  556. 

tumors,  etc.,  of,  560. 
Bowel,  cancer  of,  296. 

degenerations  of,  296,  297. 

inflammatory  disorders  of,  294- 
297 

loss  of  tone  in,  290-294. 

ulcerative  diseases  of,  296,  297. 


Bowel  disorders,  treatment  of,  291 

-296. 
Brain,  the,  16,  494,  495,  530-549. 
diseases  of,  530-549. 
education  of,  541. 
functions  of,  538,  539. 
grades  in,  537,  538. 
healthy  and  unhealthy,  546, 547. 
Brain  failure,  heredity  a  cause 
of,  540. 
misuse,  a  cause  of,  540. 
periods  of  life  which  threaten 
with,  543,  544. 
Bright's  disease,  164,  452. 
fatt}^  gouty,  and   waxy  forms 

of,  452-455. 
inflammatory    form    of,    452, 

453. 
pleurisy  very  fatal  in,  472,  473. 
pneumonia  very  fatal  in,  470. 
sequel  of  scarlatina,  353. 
varieties  of,  452. 
Bromides,  a    treacherous    medi- 
cine, 512,515,  516. 
of  use  in  organic  epileps}"^,  548. 
Bronchiectasis,  462. 
symptoms   and    treatment   of, 
482. 
Bronchitis,  462. 
capillary  (tine)  variety  of,  461, 

467,  468. 
chronic  form  of,  463,  464. 
coarse    (common)    variety^   of, 

461. 
prognosis  in,  464. 
stages  of,  463. 
treatment  of,  464-467. 
Buttermilk,  271. 
Butyl-chloral  hydrate,  507. 

Cancer  of  bone,  560. 

bowel,  296. 

brain,  535. 

heart,  327. 

kidneys,  455. 

lungs,  476. 

stomach,  288.  289. 
Capillary  bronchitis,  467,  468. 

a  cause  of  consumption,  468. 

at  different  ages.  467,  468. 

treatment  of,  468. 
Carbuncle,  435,  436. 


INDEX. 


585 


Caries,  556.  557. 
Catalepsy,  516. 
Cerebral  abscess,  534. 

anaemia,  534. 

congestion,  533,  534. 

hemorrhage,  165,  335,  583,  538. 

inflammation,  534. 

meningitis,  535,  536. 

softening,  534. 

suppuration,  534. 

thrombosis,  -533. 

tumors,  535. 
Cerebro-spinal  sclerosis,  530,  531. 
Change  of  life,  nerve  disorders  at, 

500,  543. 
Cheese,  digestibility  of,  250. 
Chicken-pox,  362,  363. 
Child-crowing,  489. 
Chloral,  507. 
Chlorosis,  394,  395. 

a  cause  of  heart  derangement, 
331. 
Cholera,  Asiatic,  365-367. 

English.  367.  368. 
Chorea  (St.  Yitus's  dance),  177, 

223,  506. 
Chrysophanic  acid,  439. 
Chyluria,  449. 
Cinchona  in  ague,  365. 
Clark,  Sir  J.,  on  humiditj^  in  air, 

78. 
Clay  soils,  75,  76. 
Clergyman's  sore-throat,  487. 
Climate,  72. 
Codeina,  304. 
Colchicum,  190. 
Cold  in  the  head,  see  Coryza. 
Colic,  157. 

Collapse  of  lung,  482. 
Colloid,  definition  and  characters 

of  a,  8,  9. 
Comedones,  or  black  heads,  431. 
Congenital  disease,  48,  49. 
Congestion,  of  lungs,  acute,  483. 

chronic,  483. 
Constipation,  581. 
Consumption,  fibroid,  416,  475. 

galloping,  474. 

inflammator}',  415,  474,  475. 

mechanical,  416. 

of  bowels,  414. 

of  brain,  535,  536. 


Consumption  of  lungs,  474. 

relation  to  food,  want  of,  144- 
146. 

treatment  of,  476. 

tubercular,  413. 
Convulsions,  epileptic,  513,  514. 

hysterical,  511,  512. 

hystero-epiieptic,  511-513. 

infantile,  144,  510,  511, 
Corpora  amylacea,  530. 
Corpulence,  see  Obesity. 

formula     for     medicines     in, 
571. 
Correspondence    with     environ- 
ment, 47,  48. 
Coryza,  486. 
Cretinism,  229. 
Crisis  in  disease,  174. 
Croup,  false,  489. 

membranous,  369-371. 

non-membranous,  487,  488. 
Crystalloids,  definition  of,  8. 
Currents  (ocean),  74. 

Damp  soils,  75,  76. 

effects  on  man  of,  77. 
Dandriff,  see  Pityriasis. 
Death,  12,  48. 
Deficiency  of  food,  diseases  due 

to,  141,  142. 
Decjenerations  of  the  blood-ves- 
sels, 333-335. 

of  the  bowel,  296,  297. 

of  the  heart,  326-328. 

of  the  kidneys,  452-455. 

of  the  lunss,  47-4-476. 

of  the  lymphatics,  408,  409. 

of  the  nervous  system,  521. 
Delirium  in  fevers  not  due  to  in- 
flammation, 496. 

tremens,  506. 
Dementia,  540,  547. 
Dengue,  359. 

Depression    of    spirits,    496^99, 
502-505,  543. 

treatment  of,  504. 
Diabetes,  true  and  false  forms  of, 
297-299. 

insipid  form  of,  451,  452. 

treatment  of,  3CJ-305. 
Diabetes,  vide  also  Glucosuria. 
Diarrhcea,  41,  157,  161. 


586 


INDEX. 


Diet,  at  various  life  periods,  576, 
577. 
in  biliousness,  171,  579,  580. 
in  constipation,  581. 
in  consumption,  580. 
in  diabetes,  304,  305. 
in  dyspepsia.  242-245.  579,  580. 
in  fever,  376-378,  578,  579. 
in  gout,  579,  580. 
in  health,  149.  150,  575. 
in  scrofuhi,  580. 
in  sickness  generally,  577. 
Dietaries,  fixed,  a  mistake,  258, 

259,  581. 
Digestion,  disorders  of  primary, 
278-297. 
secondary,  297-301. 
tertiary,  301-306. 
of  albumens,  132. 
of  fats,  135,  136. 
of  fuel-foods,  134. 
of  sugars,  135 

primary,  secondary,  and  terti- 
ary, 275-278. 
Digestive  ferments,  their  origin, 
^137. 

processes,  131,  132. 
Digitalis,  95. 
Diphtheria,  368-371. 
Diseases,  functional,  39,  40,  56. 
mortal,  40. 
organic,  40,  56. 

variation  in  mortality  of  simi- 
lar, 28. 
Dover's  powder,  use  in  coryza, 

486. 
Dropsy,  the  end  of  valvular  heart 

disease,  318  et  seq. 
Drugs,  92. 
cannot  generate  force,  41. 
some  formula?  of,  571-574. 
Dust,  man  defined  as,  5. 
Dysidrosis,  430. 
Dyspepsia,  275-306. 
acute  gastric,  156. 
atonic  gastric,  279,  280. 
chronic  gastric,  160. 
intestinal,  289-300. 
origin  of,  238-240. 

Ebstein,  sj'^stera  of,  for  reducing 
corpulence,  207. 


Ecthyma,  425. 
its    origin,   sometinaes    scrofu- 
lous, 436. 
Eczema,  425. 

its    origin,  sometimes    scrofu- 
lous, 436. 
treatment  of,  427. 
Electricity,  varieties  of,  in  use, 

116. 
Elements,  the  six  which  compose 

the  germ-cell,  5. 
Elephantiasis  of  the  Arabs  and  of 
the  Greeks,  440,  441. 
treatment,  441. 
Embolus,  332,  333. 
Emphysema,  462,  478. 
Empj-aema,  474. 
Energy,  that  in  a  germ-cell,  7. 
that  in  clock  mechanism,  7. 
Enteric  fever,  354-356. 
Environment  of  a  germ-cell,  10, 
26. 
of  man,  his  mould,  90. 
Epidemic  cerebro-spinal   menin- 
gitis, 365. 
roseola,  352. 
Epilepsy,  222,  223,  513-516,  548. 
functional  variety  (reflex),  513. 
importance  of  diet  in.  515. 
Jacksonian  form  of,  514. 
organic  variety,  548. 
sexual  organs  often  at  fault  in, 

515. 
sometimes  caused  by  gout  poi- 
son, 198. 
symptoms  of,  513,  514. 
treatment  of  functional,  514. 
organic,  548. 
Equilibrium,  disturbances  of,  38, 
39. 
moving,  stable,  and  unstable, 

22. 
perfect  and  imperfect,  38,  39. 
Ergot  of  rye,  222. 
Erroneous  views  of  disease,  86. 
Erysipelas,  382-384. 

varieties  of,  383,  384. 
Erythema,  383. 

nodosum,  435. 
Examples  of  disease  (functional), 
43,  44. 

(organic),  46,  47. 


I>7DEX. 


587 


Examples  of  therapeutic  fallacies, 
103-106. 

Exercise,  167. 

Exophthalmic  goitre,  395,  396. 

Extraordinary  measures  of  treat- 
ment, 85,  86. 

Faith-healing,  remarks  on,  118. 
Fallacies  of  hygienists.  79-85. 
of  orthodox  physic,  32,  40,  41. 

59. 
of  therapeutists,  102-107. 
Famine  fever,  358. 
Fats,  221,  245-247. 
digestion  of,  136. 
disHked    and    mal-digested   in 

scrofula,  412. 
relative    digestibility    of,   246, 
247. 
Festinant  gait,  531. 
Fevers,  the,  347. 

characters  common  to  all,  347. 
Fevers,  genesis  of,  344-346. 
list  and  stages  of,  347-349. 
treatment  of,  349,  373-378. 
Fibrosis  of  skin,  440. 
Fish-skin,  see  Ichthyosis. 
Fits,  nee  Convulsions. 
Flatulence,  279,  290. 
Food,  59,  60. 
absolutely  unfit  for  man,  217. 
accessories,  70. 

before  and  after  digestion,  11. 
considered  in  detail,  130  e^  ''jeq. 
deficiency  of,  a  cause  of  disor- 
der, 141. 
digestion  of,  131-137. 
diseases  due  to  excess  of,  155. 
fuel,  circumstances  modifying 
demand  for,  151. 
digestion  of,  134. 
in  disease,  68. 
in  health,  60,  66,  130. 
normal  demand  for,  150. 
the  cause  of  motion,  13,  14. 
varieties  of,  68,  69. 
improper  flesh,  217,  218. 

liquid,  224. 
organs,  a  list  of  them,  14,  15, 

309,  310. 
putrid,  219,  220. 
relatively  improper,  237- 


Food,  sources  and  destiny  of  hu- 
man, 129. 
tissue,  59,  60. 
digestion  of,  132. 
the  cause  of  gi'owth,  11,  12. 
in  disea.se,  63-66. 
in  health,  60,  61. 
Food  system,  129-490. 
organs  of,  138. 

pre-eminently  the  system,  175. 
Formulae,  571-574. 
Functional  disease,  35-40. 
Fur,    proximity   of,   may   cause 
asthma,  477. 

Gairdner,  Prof. ,  on  medical  or- 
thodoxies, 89. 
Gall-stones,  formation  of,  200. 

effect  of  salicylic  acid  on,  306. 

treatm.ent  of,  201,  305,  306. 
Gastric  catarrh  (acute),  156,  157, 

■    283-286. 

(chronic),  286-288. 
German  Measles,  352. 
Germ-cell,  1-12,  54,  57,  58. 

energy  resident  in,  8. 

starting  point  of  life,  5. 
Germs,  fever,  genesis  of,  230-235. 
Germs,  transit  of,  234. 
Gin,  258. 

Girdle  pains  in  locomotor  ataxia, 
410. 

in  shaking  palsy,  413. 
Glandular  swellings  in  scrofula, 

412,  413. 
Glucosuria,  genesis  of,  197,  299. 

meaning  of,  197. 

permanent  (diabetes),  196. 

symptoms  of,  198. 

temporary,  196. 

treatment  of,  199,  200,  303-305. 
Goitre,  228. 
Gout,  408. 

acute  and  chronic,  163,  164. 

genesis  of,  299. 

latent,  177. 

lung  affections  in,  194. 

skin  diseases  in,  191,  192. 

symptoms  of,  acute  and  chron- 
ic, 165. 

treatment  of  acute,  168,  169. 
of  chronic,  166-168. 


"688 


INDEX. 


Gouty  Bright's  disease,  IGo,  453. 
Graad-mal,  513. 
Gravel.  163. 

Graves's  disease,  395,  396. 
Growth   in   man,  takes  form   of 
cell  multiplication,  9,  10. 
rationale  of  the  process,  10. 
Guarana,  508. 

Habits,  82,  83. 

Haematuria,  449. 

Haemoptysis,  ^ee  Blood-spitting. 

Hair,  affections  of  the,  431. 

Hay  asthma,  480. 

Health,  a  state  of  balance,  31,  32. 

principles  of.  19-33. 
"  Health,  Beauty,  and    the   Toi- 
let," by  Dr. 'Kingsford,  281. 
Heart,  functions  of,  317. 

malformation  of,  324. 

weak,  329. 
Heart    diseases,    165,    180,    310- 
332. 

course  of  several,  318-828. 

due  to  degeneration,  326,  327. 

functional  forms  of,  328. 

general  remarks  on,  310. 
treatment  of,  314  et  aeq. 

genesis  of  some  forms  of,  313. 

inflammatory,  324-326. 

valvular.  314-320,  322,  323. 

various  forms  of,  818,  332. 
Hemicrania,  me  Migraine. 
Herpes  Zoster,  434. 

symptoms    and    treatment   of, 
434. 
Hodgkin's  disease,  392. 
Hufeland,  quotation  from.  89. 
H5'drocephalus,  acute,  535. 

chronic,  536,  537. 
Hydro-pericardium,  319. 
Hydro-peritoneum,  319. 
Hydrophobia,  387-389. 
Hydro-thorax,  319. 
Hyperidrosis,  429. 
Hypochondriasis,  146,  498-502. 

treatment  of,  501.  502. 
Hysteria,  146,  500-502.  ^ 

a    cause    of    spinal   irritation, 
508. 

treatment  of,  501. 
Hystcro-epilepsy,  511-513. 


Ichthyosis,  441 

Ideal  man,  fallacy  of  the,  84,  85. 

Ill-health,  chronic,  35, 

principles  of,  37-50. 
Impetigo,  439. 

Impotencies,  sexual,  easily  cura- 
ble, 564-566. 

the  consequence  of  nerve  dis- 
turbance, 564,  567. 
Impressions,  cure  b3%  118,  119. 
Indigestion,  see  Dyspepsia. 
Influenza,  350,  351. 
Inflammation  of  bones,  556. 

bowel,  294. 

brain,  534. 

lung,  461,  468. 

membranes  of  brain,  535. 

kidney,  acute  and  chronic,  4o0, 
451. 

skin,  425. 

stomach.  282,  283. 
Insanity    of   change    of    life    in 
women,  543. 

of  puberty.  147.  180. 

standard  of,  legal,  546. 
Intermittent  fever,  363-365. 
Intestinal  derangement,  cause  of 
asthma,  478. 

worms,  222,  223. 
Intestine,  see  Bowel. 
Iron  in  chlorosis,  395. 
Irritability,  502. 
Itch,  444,  445. 

treatment  of,  445. 

Jaundice,  294. 

Kidneys,  cancer  of,  455. 

cystic  degeneration  of,  455. 

degenerations  of,  451-455. 

disorders  of,  446-450. 

functional   disorders  of,    450- 
452. 

functions  of,  446. 

hydatid  cysts  of,  455. 

inflammation  of,  450,  451. 

strumous  disease  of,  455. 
Koumiss,  preparation   and   uses 
of,  271. 

Laryngeal  mucoiis  membrane, 
congestion  of,  487. 


INDEX. 


589 


Larynx,  disorders  of,  486-489. 
seldom  seat  of  disease,  486. 
Lead  in  water,  225,  226. 

poisoning,  226,  227. 
Leonine  face  in  leprosy,  44L 
Leprosy,  440,  441. 
Leucocythsemia,  391,  392. 
Lice,  444. 
Lichen,  434,  435. 

symptoms   and    treatment    of, 

434,  435. 
sometimes  due  to  kidney  fail- 
ure, 436. 
Liclien  scrophulosorum,  438. 
Life,  principles  of,  3-15. 
Liver,  degenerations  of,  300,  301. 
disturbances  of,  162. 
failure  of,  as  an  excretory  or- 
gan, 200. 
in     converting     albumen, 

163. 
in    manufacture    of    bile- 
acids,  169. 
in  storage  of  glycogen,  196. 
in  supplying  blood  serum, 
177,  178. 
five  great  functions  of,  162. 
overwork  of,  162. 
Liver  spot,  treatment  of,  444. 
Lobular  pneumonia,  see  Capillary 

Bronchitis. 
Lockjaw,  see  Tetanus. 
Lungs,  abscess  of,  461. 
cancer  of,  461. 
collapse  of,  462,  482. 
congestion  of,  462,  483. 
consumjDtion  of,  461,  474-476. 
degenerations  of,  474-484. 
functional   disorders    of,  462- 

474. 
functions  of,  459,  460. 
inflammation  of,  461, 
mortification  of,  461. 
structure  of,  460,  461. 
why  so  often  attacked  by  dis- 
ease, 459,  460, 
Lupus,  non-ulcerating   form  of, 
437. 
symptoms    of  both  forms   of, 
'  437. 

treatment    of   both    forms    of, 
437. 


Lupus,  ulcerating  form  of,  437. 
Lymphatics,  401-419. 
functional    disorders    of,   404- 

408. 
organic  diseases  of,  408-419. 
organs  of,  401-403. 
structural  arrangement  of,  401- 
403, 

Man  a  machine,  15. 
Management  of  sick-room,  582. 
Massage,  120. 
Mastication,  137. 
Measles,  351,  352. 
Medicine,  fallacies  of  orthodox, 
32,  41-43,  101-107. 
principles  of,  51-122. 
Medicines,  action  on  body  at  large 
of,  92. 
alterative,  94,  95. 
as  antidotes,  93,  97. 
as  elements  of  bodily  disturb- 
ance, 94. 
as  foods,  92. 

as  mechanical  scavengers,  96. 
classification  of,  92. 
stimulating,  94. 
tonic,  95. 
jMichelet,  quotation  from,  53. 
Migraine,  394. 
jVIiliary  fever,  430. 
Milk,  characters  of,  269. 

pancreatized,  271, 
Mitral    orifice,  derangement    of, 
318,  319. 
valves,  derangement    of,   319- 
321. 
^Molecules  of  germ-cell,  6,  7. 
^Molluscum,  431. 
Mortal  disease,  40. 
Motor  system,  16,  553-560. 

organs  of,  16,  429. 
Mouth,  nervous  connections  with 
stomach  of,  278,  279. 
state  of,  in  atony  of  stomach, 
279. 

gastric    catarrh,  284,  288, 
289. 
Movements  in   man's  body,  me- 
chanical, 54,  55. 
molecular,  55. 
Muscles,  the,  553,  554. 


590 


INDEX. 


Muscles,  functional  disorders  of, 
554. 
organic  diseases  of,  555. 
Mumps,  350. 
Myelitis,  530. 
Myxo-'dema,  440. 

Nails,  affections  of,  431. 
Native  air,  effects  of,  31. 
Natural,  misuse  of  tlie  term,  82, 

83,  103. 
Necrosis,  557. 
Nerve  centres,  reflex,  494. 

in  brain,  495. 
Nerve  disorders,  493-549 
functional,  495-518. 
organic,  521-549. 
reflex,  508-510. 
Nerves,  afferent  (or  sensory),  493. 
cranial,  522-524. 
efferent  (or  motor),  493. 
of  skin,  affections  of,  432-434. 
spinal,  521,  522. 
Nervous  debility,  595-597. 
a   cause   of   atonic  dyspepsia, 
279,  291. 
of  diabetes,  198. 
of  gout   and    gravel,  163, 
164. 
the  cause  in,  not  the  sequence 
of,  sexual  disorder,  565,  567. 
Nervous  storms  at  certain  periods 

of  life,  498. 
Nervous   system,  organs   of,  15, 
16. 
plan  of,  111-114.  493. 
Nettle-rash,  432,  433. 
Neuralgia,  506,  507. 
common  in  shingles,  434. 
treatment  of,  507. 
Neuritis,  521. 
Nitrite  of  amyl,  480,  481. 
Nitrogen  in  air,  72. 
part  played  by  it  in  life,  6. 

Obesity,  204. 

causes  of,  204-203. 

treatment  of,  206  et  seq. 

(Ertel's  system,  208. 
Orgunic  di.sease,  its  nature,  27,  40. 
Orthodox  therapeutists,  blunders 
of,  102  ei  seq. 


Osteitis  deformans,  560. 
Osteomalacia,  559,  560. 
Ox5^gen  in  air,  72. 
Ozone  in  air,  72. 
use  in  fevers,  374. 

Pachymeningitis,  536. 
Palpitation,  329,  331. 

treatment  of,  330,  331. 
Paralysis  (palsy),  acute  ascend- 
ing, 529. 

agitans  (shaking),  531. 

Bell's,  523. 

bulbar,  525. 

creeping  and  infantile,  526,  527. 

local  and  temporary,  508. 

mercurial  and  lead,  529. 

progressive,  of  the  insane,  549. 

pseudo-hypertrophic,  527. 

reflex,  517,  518. 

scrivener's,  505,  506. 

spastic  spinal,  527,  528. 
Parasites  of  bowel,  222,  223. 

of  muscle,  223. 
Parasitic  skin  affections,  441-445. 
Parotid  gland,  350. 
Peisse,  quotation  from,  89. 
Pemphigus,  437,  438. 
Pendulum    of   clock,  simile   of, 

39. 
Pepsin,  pancreatin,  etc.,  70,  71, 

93,  94. 
Pericarditis,  325,  326. 
Periosteum,  555. 
Periostitis,  557,  558. 
Petit  mal,  513,  514. 
Physico-mental  agents,  109  et  seq. 
Phosphaturia,  449. 
Phthisis,  forms  of,  461,  474-476. 
Pigeon-breast,  558. 
Pityriasis,  439,  440. 
Plague,  357. 
Pleuri.sy,  180,  461,  471-474. 

causes  of,  471. 

common    in    Bright 's   disease, 
472. 

stages  of,  471,  472. 

tapping  it,  473,  474. 

treatment  of,  472-474. 
Pleurodynia,  554. 
Pneumonia,  461,  469-471. 

a  cause  of  consumption,  470. 


INDEX. 


591 


Pneumonia,    Hughes     Bennett's 
experiments  in,  470. 

in  women  and  children,  469. 

stages  of,  468,  469. 

treatment  of,  470,  471. 
Poisons  in  blood-stream,  340-389. 
Polypus,  489. 
Polyuria.  451,  452. 

treatment  of,  452. 
Principles  of  health,  21. 

of  ill-health,  37. 

of  life,  3-15. 

of  scientific  medicine,  53. 
Progressive     muscular     atrophy 
(creeping  palsy),  526,  527. 

pernicious  amemia,  393. 
Prurigo,  433,  434. 

common  in  diabetes  and  jaun- 
dice, 434. 

kidney  failure,  436. 

treatment  of,  433. 
Psoriasis,  438,  439. 

treatment  of,  438,  439. 
Ptomaines,  224. 

the   poison   in   some  mussels, 
220. 
Puberty,  effects  on  brain,  543. 

insanity  of,  147. 
Puerperal  fever,  385. 
Purgatives,  some  useful,  572. 

medicines  discussed,  96. 
Purpura  simplex,  389,  390. 

hcemorrhagica,  390. 
Pycemia,  384,  385. 
Pyrexia,  see  Fever. 


Quinine  in  ague, 
Quinsy,  196,  485. 


)0. 


REGnrE,  grape,  217. 

milk,  269. 

vegetarian,  259. 
Relapsing  fever,  358. 
Remittent  fever,  363. 
Reproductive  system,  17, 563-567. 

functional    derangements     of, 
564-566. 

organic  disease  of,  566. 
Rlieumatic  fever,  180,  404,  405, 
407,  408. 

genesis  of,  180,  301,  302. 

treatment  of,  188,  407,  408. 


Rheumatic  fever,  uric  acid   the 

main  poison  of,  180,  181,  404. 
Rheumatic    poison,    a   cause   of 

chorea,  506. 
Rheumatism,  chronic,  183  ct  seq. 

lung  affections  in,  194. 

muscular,  180. 

skin  affections  in,  191, 192. 

treatment  of,  406. 
Rickets,  558-560. 

adult,  559,  560. 
Ringworm,  common  form  of,  441, 
442. 

honeycomb  form  of,  441. 

treatment  of  both  forms  of,  442, 
443. 
Rye,  222. 

St.  Virus's  Dance,  see  Chorea. 

Salicine     and     salicylates,     189, 

191. 
Salts,  a  necessary  food,  131. 

normal  bodily  needs  of,  69,  70, 
151,  152. 

place  of,  iri  disease,  70. 
Scabies,  see  Itch. 
Scarlet  fever,  352-354. 
Scleroderma,  440. 
Scrofula,  410  et  seq. 

types  of,' 410,  411. 
Scurvy,  390,  391. 
Seborrhoea,  430. 
See,  Dr.,  on  alcohol,  255,  256. 

on  obesity,  207,  208. 
Shaking  palsy,  531. 
Shingles,  see  Herpes  Zoster. 
Sick-room,  its  arrangement,  582. 
Simple  ansemia,  393,  394. 

continued  fever,  349,  350. 
Skin,  functions  of,  423. 
Skin,  diseases  of,  424-446. 

meaning  of,  192-194,  445,  446. 

of  gouty  origin,  191,  192,  425- 
428. 

of  rheumatic  origin,  191,  192. 

of  scrofulous  origin,  436-440. 

of  syphilitic  origin,  428,  429. 

of  parasitic  origin,  441-445. 
Small-pox,  359-362. 
Soils  and  sub-soils,  75-78. 
Spencer,      Herbert,      quotations 
from,  21,  37. 


592 


INDEX. 


Spinal  cord,    auterior  born,    in- 
flammation of,  527. 

columns   and   membranes    of, 
525,  526. 

gray  matter  of,  diseases  of,  526, 
527. 

inflammation  of,  526. 

organic  diseases  of,  525-530. 

wbite  matter  of ,  diseases  of,  527- 
530. 
Spinal  irritation,  508. 
Spitting  of  blood,  414,  415. 
Stimulant,  alcobolic,  250-258. 

medicines,  94. 
Standards  in  diet,  wby  fallacious, 

23,  24. 
Starch-foods,     adulterations     in 
some,  221. 

digestion  of,  134,  247,  248. 
Starvation,  rapid,  141,  142. 

treatment  of,  142,  143. 
Starvation,  slow,  142. 

in  adolescence,  145,  146. 

in  baby  life,  144. 

in  childhood,  145. 

in  middle  life,  147. 

in  old  age,  148. 

symptoms   and   treatment   of, 
144,  148,  149. 
Stomach,  atony  of,  279-282. 

cancer  of,  289. 

dilatation  of,  289. 

inflammatory  disorders  of,  283- 
288. 

ulcer  of,  288,  289. 
Stone,  chalk,  165. 

gall,  300. 

phosphatic,  228. 

uric  acid,  163. 
Sudamina,  430. 
Sugar,  digestion  of,  135. 

grape,  134,  297,  298. 

question  of  digestibility  of,  248, 
249. 

unfermented,  in  wines,  257, 258. 
Sunstroke,  548,  549. 
Sycosis,  442. 

Symptoms   cannot  produce  dis- 
ease, 40. 
Syphilis,  378-380,  408,  416-419. 

congenital,  417,  418. 

sequeUc  of,  419. 


Syphilis,  treatment  of,  380,  417, 

418. 
Syphilitic  skin  affections,  428, 429. 

Tannin  in  tea,  not  a  cause  of  d3^G. 

pepsia,  249. 
Tape-worm,  222,  223. 

treatment  of,  223. 
Tea,  249. 
Tetanus,  385-387. 
Tetany,  516,  517. 

often  due  to  dentition,  516. 
Thirst,  a  symptom  of  gastric  ca- 
tarrh, 287. 

a  symptom  of  glucosuria  (dia- 
betes)  298. 
Tliroat,  disorders  of,  484-487. 

inflamed,  485,  486. 

relaxed,  487. 
Thrombus,  332,  333. 
Tinea  favosa,  see  Ringworm. 

tonsurans,  see  Ringworm. 

versicolor,  see  Liver-spot. 
Tissue-foods  or  albumen,  59,63,64. 

considered  in  detail,  129  et  seq. 

excess  of,  62. 

in  disease,  63,  64. 

reservoir  of,  in  blood,  63. 
Toad-rock,  38. 
Tobacco,  82,  102,  103. 
Tolerance  of  poisons,  27,  343,  343. 
Tonics,  95. 
Tonsils,  acutely  inflamed,  484. 

enlarged,  rheumatic,  and  scrof- 
ulous, 484,  485. 
Treatment,      by      extraordinary 
measures,  89-109. 

by  ordinary  measures,  53-86. 

lines  on  which  to  conduct  drug, 
107,  108. 
Tubercular  consumption,  413. 
Tuberculosis,  381,  382. 
Tumors,  49,  50. 
Typhoid  fever,  354-356. 
Typhus  fever,  356-358. 

Ulceration  of  bowels,  296,  297. 

womb.  439. 
Ulcer  of  stomach,  288,  289. 
Uric  acid  and  urates,  color  of,  450. 

the  poisons  of  gout,  164. 
of  rheumatism,  180,  181. 


INDEX. 


593 


Urine,  a  guide  to  diagnosis,  447. 

448. 
albumen  in.  448. 
b]ood-pi2,-ment  in,  449. 
chyle  in.^449. 
deposits  of  sand  and  gravel  in, 

450. 
ceueral  remarks  on,  446,  448. 
oil  in,  448. 
sugar  in,  448. 

phosphates  (in  excess)  in,  449. 
uric   acid  and  urates  in,  449, 

450. 
Urticaria,  see  xSettle-rash. 

Yaccixation,  question   of,  361, 

362. 
Vegetarianism,  259. 

pros  and  cons,  259-268. 
Vertigo,  496. 


Warburg's  fever  tincture,  365.      YELLO^Y  Fever,  358,  359. 


Water,  as  a  food,  131. 

contaminations  of,  225. 
Water,  tiltration  of,  228. 

hard,    does    not    cause    stone, 
228. 

normal  demand  for,  69,  70. 

organic  matter  in,  230. 

place  in  diseased  states,  70. 

to   purify  from    fever   germs, 
236,  237. 
Water  on  the  brain,  536,  537. 
Weak  heart,  the  bogie  of  a,  328. 

329. 
Whey,  271. 
Whiskey,  258. 
Whooping-cough,  371,  372. 
Writer's  cramp,  505. 

Xanthelasma,  431. 
in  kidney  failure,  436. 


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Milman,  M.  Gd:zot,  and  Dr.  William  Smith.  New  Edi- 
tion, from  New  Electrotype  Plates.  G  vols.,  8ro,  Cloth,  with 
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GOLDSMITH'S  WORKS.  The  Works  of  Oliver  Goldsmiih. 
Edited  by  Petek  Cunningham,  F.S.A.  From  New  Electro- 
type Plates.  4  vols.,  8vo,  Cloth,  Paper  Labels,  Uncut  Edges 
and  Gilt  Tops,  $S  00  ;   Sheep,  $10  00;  Half  Calf,  $17  00. 

MOTLEY'S  LETTERS.  The  Correspondence  of  John  Lothrop 
Motley,  D.C.L.,  Author  of  "The  United  Netherlands,"  "John  of 
Barneveld,"  "  The  Rise  of  the  Dutch  Republic,"  etc.  Edited  by 
GicoRGE   William    Curtis.      With   Portrait.     Two    Volumes, 

8vo,  Cloth,  $7  00. 

MOTLEY'S  DUTCH  REPUBLIC.  The  Rise  of  the  Dutch  Re- 
public. A  History.  By  John  Lothrop  JNIotley,  LL.D., 
D.C.L.  With  a  Portrait  of  William  of  Orange.  Cheap  Edi- 
tion, 3  vols.,  in  a  Box.  8vo,  Cloth,  Avith  Pajier  Labels,  Uncut 
Edges  and  Gilt  Top«,  $6  00;  Sheep,  $7  50;  Half  Calf,  $12  75. 
Sold  only  in  Sets.      Library  Edition,  3  vols.,  8vo,  Cloth,  $10  50. 

MOTLEY'S  UNITED  NETHERLANDS.  History  of  th-e  Unit- 
ed Netherlands :  From  the  Death  of  William  the  Silent  to  the 
Twelve  Years'  Truce— 1584-1  GOO.  With  a  full  View  of  the 
English-Dutch  Struggle  against  Spain,  and  of  the  Origin  and 
Destruction  of  the  Spanish  Armada.  By  John  Lothrop  Mot- 
ley, LL.D.,  D.C.L.  Portraits.  Cheap  Edition,  4  vols.,  in  a 
Box,  8vo,  Cloth,  with  Paper  Labels,  Uncut  Edges  and  Gilt  Tops, 
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Original  Library  Edition,  4  vols.,  8vo,  Cloth,  $14  00. 

MOTLEY'S  JOHN  OF  BARNEVELD.  The  Life  and  Death  of 
John  of  Barneveld,  Advocate  of  Holland.  With  a  View  of  the 
Primary  Causes  and  Movements  of  the  "Thirty  Years' War." 
By  John  Lothrop  Motley,  LL.D.,  D.C.L.  Illustrated. 
Cheap  Edition,  2  vols.,  in  a  Box,  8vo,  Cloth,  Avith  Paper  La- 
bels, Uncut  Edges  and  Gilt  Tops,  $4  00 :  Sheep,  $5  00 ;  Half 
Calf,  $8  50.  Sold  only  in  Sets.  Original  Library  Edition,  2 
vols.,  8vo,  Cloth,  $7  OO'. 

HILDRETH'S  UNITED  STATES.  History  of  the  United 
States.  First  Series  :  From  the  Discovery  of  the  Continent 
to  the  Organization  of  the  Government  under  the  Federal  Con- 
stitution. Si'XOND  Series  :  From  the  Adoption  of  the  Federal 
Constitution  to  the  End  of  the  Sixteenth  Congress.  By  Rich- 
ard Hildrkth.  Po])iilar  Edition,  G  vols.,  in  a  Box,  8vo, 
Cloth,  Avith  Paper  Labels,  Uncut  Edges  and  Gilt  Top.s  $12  00; 
Sheep,  $15  00;  Half  Calf,  $25  50.      Sold  only  in  Sets. 


Valuable  Works  for  Public  and  Private  Libranes.  3 

STORMONTH'S  ENGLISH  DICTIONARY.  A  Dictionary  of 
the  English  Language,  Pronouncing,  Etymological,  and  Ex- 
planatory: embracing  Scientific  and  other  Terms,  Numerous 
Familiar  Terms,  and  a  Copious  Selection  of  Old  English  Words. 
By  the  Rev.  James  Stormonth.  The  Pronunciation  Revised 
by  the  Rev.  P.  H.  Phelp,  M.A,  Imperial  8vo,  Cloth,  $6  00; 
Half  Roan,  $7  00;  Full  Sheep,  $7  50.      (New  Edition.) 

PARTON'S  CARICATURE.  Caricature  and  Other  Comic  Art, 
in  All  Times  and  Many  Lands.  By  James  Parton.  203  Illus- 
trations, 8vo,  Cloth,  Uncut  Edges  and  Gilt  Tops,  $5  00  ;  Half 
Calf,  $7  25. 

DU  CHAILLU'S  LAND  OF  THE  MIDNIGHT  SUN.  Sum- 
mer and  "Winter  Journeys  in  Sweden,  Norway,  Lapland,  and 
Northern  Finland.  By  Paul  B.  Du  Ciiaillu.  Illustrated. 
2  vols.,  8vo,  Cloth,  $7  50;  Half  Calf,  $12  00. 

LOSSING'S  CYCLOP.^DIA  OF  UNITED  STATES  HISTO- 
RY. From  the  Aboriginal  Period  to  1876.  By  B.  J.  Los- 
sing,  LL.D.  Illustrated  by  2  Steel  Portraits  and  over  1000 
Engravings.  2  vols.,  Royal  8vo,  Cloth,  $10  00  ;  Sheep,  $12  00 ; 
Half  Morocco,  $15  00.      (Sold  by  Subscription  only.) 

LOSSING'S  FIELD-BOOK  OF  THE  REVOLUTION.  Pic- 
torial Field -Book  of  the  Revolution;  or,  Illustrations  by  Pen 
and  Pencil  of  the  History,  Biography,  Scenery,  Relics,  and  Tra- 
ditions of  the  War  for  Independence.  By  Benson  J.  Lossing. 
2  vols.,  8vo,  Cloth,  $U  00;  Sheep  or  Roan,  $15  00;  Half  Calf, 
$18  00. 

LOSSING'S  FIELD-BOOK  OF  THE  WAR  OF  1812.  Pic^ 
torial  Field-Book  of  the  War  of  1812  ;  or.  Illustrations  by  Pen 
and  Pencil  of  the  History,  Biography,  Scenery,  Relics,  and  Tra- 
ditions of  the  last  War  for  American  Independence.  By  Ben- 
son J.  Lossing.  With  several  hundred  Engravings.  1088 
pages,  8vo,  Cloth,  $7  00;  Sheep  or  Roan,  $8  50;  Half  Calf, 
$10  00. 

JHULLER'S  POLITICAL  HISTORY  OF  RECENT  TIMES 
(1816-1875).  With  Special  Reference  to  Germany.  By  Will- 
iam MiJLLEE.  Translated,  with  an  Appendix  covering  the 
Period  from  1876  to  1881,  by  the  Rev.  John  P.  Peters,  Ph.D. 
12mo,  Cloth,  $3  00. 


4  Valuable  Works  for  Puhlio  and  Private  Libraries^ 

TKEVELYAN'S  LIFE  OF  MACAULAY.  The  Life  and  Let- 
ters of  Lord  Macaulay.  By  his  Nephew,  G.  Otto  Tkevbltan, 
M.P.  With  Portrait  on  Steel.  2  vols.,  8vo,  Cloth,  Uncut 
Edges  and  Gilt  Tops,  $5  00 ;  Sheep,  $6  00 ;  Half  Calf,  $9  50. 
Popular  Edition,  2  vols,  in  one,  12mo,  Cloth,  $1  75. 

TKEVELYAN'S  LIFE  OF  FOX.  The  Early  History  of  Charles 
James  Fox.  By  George  Otto  Trbveltan.  8vo,  Cloth,  Un- 
cut Edges  and  Gilt  Tops,  $2  50 ;   Half  Calf,  $4  75. 

WRITINGS  AND  SPEECHES  OF  SAMUEL  J.  TILDEN. 
Edited  by  John  Bigelow.  2  vols.,  8vo,  Cloth,  Gilt  Tops  and 
Uncut  Edges,  $6  00  per  set. 

GENERAL  DIX'S  MEMOIRS.  Memoirs  of  John  Adams  Dlx. 
Compiled  by  his  Son,  Morgan  Dix.  With  Five  Steel-plate 
Portraits.  2  vols.,  8vo,  Cloth,  Gilt  Tops  and  Uncut  Edges, 
$5  00. 

HUNT'S  MEMOIR  OF  MRS.  LIVINGSTON.  A  Memoir  of 
Mrs,  Edward  Livingston.  With  Letters  hitherto  Unpublished. 
By  Louise  Livingston  Hunt.     12mo,  Cloth,  f  1  25. 

GEORGE  ELIOT'S  LIFE.  George  Eliot's  Life,  Related  in  her 
Letters  and  Journals.  Arranged  and  Edited  by  her  Hus- 
band, J.  W.  Cross.  Portraits  and  Illustrations,  In  Three 
Volumes.  12mo,  Cloth,  $3  75.  New  Edition,  with  Fresh  Mat- 
ter. (Uniform  with  "Harper's  Library  Edition"  of  George 
Eliot's  Works.) 

PEARS'S  FALL  OF  CONSTANTINOPLE.  The  Fall  of  Con- 
stantinople. Being  the  Story  of  the  Fourth  Crusade.  By 
Edwin  Pears,  LL.B.     8vo,  Cloth,  $2  50. 

RANKE'S  UNIVERSAL  HISTORY.  The  Oldest  Historical 
Group  of  Nations  and  the  Greeks.  By  Leopold  von  Ranke. 
Edited  by  G.  W.  Prothero,  Fellow  and  Tutor  of  King's  Col- 
lege, Cambridge.     Vol.  I.     8vo,  Cloth,  $2  50. 

IJFE  AND   TIMES   OF  THE   REV.  SYDNEY  SMITH.     A 

Sketch  of  the  Life  and  Times  of  the  Rev.  Sydney  Smith. 
Based  on  Family  Documents  and  the  Recollections  of  Personal 
Friends.  By  Stuart  J.  Reid.  With  Steel-plate  Portrait  and 
Illustrations.     8vo,  Cloth,  $3  00. 


Valuable  JVoi'hs  for  PuMio  and  Private  Libraries.  5 

STANLEY'S  THROUGH  THE  DARK  CONTINENT.  Through 
the  Dark  Continent ;  or,  Tlic  Sources  of  the  Nile,  Around  the 
Great  Lakes  of  Equatorial  Africa,  and  Down  the  Livingrstonc 
River  to  the  Atlantic  Ocean.  14*0  Illustrations  and  10  Maps. 
By  H.  M.  Stanley.  2  vols.,  8vo,  Cloth,  $10  00;  Sheep, 
$12  00;  Half  Morocco,  $15  00. 

STANLEY'S  CONGO.  The  Congo  and  the  Founding  of  its 
Free  State,  a  Story  of  Work  and  Exploration.  With  over  One 
Hundred  Full-page  and  smaller  Illustrations,  Two  Large  Maps, 
and  several  smaller  ones.  By  H.  M.  Stanley.  2  vols.,  8vo, 
Cloth,  $10  00;  Sheep,  $12  00;   Half  Morocco,  $15  00. 

GREEN'S  ENGLISH  PEOPLE.  History  of  the  English  Peo- 
ple. By  John  Richard  Green,  M.A.  With  Maps.  4  vols., 
8vo,  Cloth,  $10  00;   Sheep,  $12  00;   Half  Calf,  $11)  00. 

GREEN'S  MAKING  OF  ENGLAND.  The  Making  of  Eng- 
land.    By  John  Richard  Green.     With  Maps.     Svo,  Cloth, 

$2  50  ;  Sheep,  $3  00  ;   Half  Calf,  $3  75. 

GREEN'S  CONQUEST  OF  ENGLAND.  The  Conquest  of  Eng- 
land.  By  John  Richard  Green.  With  Maps.  Svo,  Cloth, 
$2  50;  Sheep,  $3  00;  Half  Calf,  $3  75. 

BAKER'S  ISMAILIA  :  a  Narrative  of  the  Expedition  to  Central 
Africa  for  the  Suppression  of  the  Slave-trade,  organized  by  Is- 
mail, Khedive  of  Egypt.  By  Sir  Samuel  W.  Baker.  With 
Maps,  Portraits,  and  Illustrations.  Svo,  Cloth,  $5  00;  Half 
Calf,  $7  25. 

ENGLISH  MEN  OF  LETTERS.     Edited  by  John  Morley. 

The  following  volumes  are  now  ready.     Others  will  follow: 

Johnson.  By  L.  Stephen. — Gibbon.  By  J.  C.  Morison. — Scott.  By  R.  H. 
Hutton. — Shelley.  By  J.  A.  Symonds. — Goldsmith.  By  W.  IJlack. — Hume. 
By  Professor  Huxley. — Defoe.  By  W.  Jlinto. — Burns.  By  Principal  Shairp. 
— Spenser.  By  R.  W.  Church. — Thackeray.  By  A.  Trollope. — Burke.  By 
J.  Morley. — Milton.  By  M.  Pattison. — Southey.  By  E.  Dowden. — Chaucek. 
By  A.  W.  Ward.— BuNYAN.  By  J.  A.  Froude.— Cowper.  By  G.  Smith.— 
Pope.  By  L.  Stephen. — Byron.  By  J.Nichols. — Locke.  By  T.  Fowler. — 
Wordsworth.  By  F.  W.  H.  Myers. — Hawthorne.  By  Henry  James,  Jr. — 
Dryden.  By  G.  Saintsbury. — Landor.  By  S.  Colvin. — Pe  Quincey.  By  P. 
Masson. — Lamb.  By  A.  Ainger. — Bentley.  By  R.  C.  Jcbb. — Dickens.  By 
A.  W.  Ward. — Gray.  By  E.  W.  Gosse. — Swift.  By  L.  Stephen.— Sterne.  By 
H.  D.  Traill. — Macaulay.  By  J.  C.  Morison. — Fielding.  By  A.  Dobson. — 
Sheridan.  By  Mrs.  Oliphaut. — Addison.  By  W.  J.  Courthope. — Bacon.  By 
R.  W.  Church.— Coleridge.  By  H.  D.  Traill.- Sir  Philip  Sidney.  By  J.  A. 
Symonds.— Keats.     By  S.  Colvin.     12mo,  Cloth,  75  cents  per  volume. 

Popular   Edition.     3G  volumes  in  12,  $12  00. 


6  Valuahle  Works  for  Public  and  Private  Libraries. 

COLERIDGE'S  WORKS.  The  Complete  Works  of  Samuel  Tay- 
lor Coleridge.  With  an  Introductory  Essay  upon  his  Philosoph- 
ical and  Theological  Opinions.  Edited  by  Professor  W.  G.  T. 
Shedd.  With  Steel  Portrait,  and  an  Index.  7  vols.,  12nio, 
Cloth,  $2  00  per  volume  ;  $12  00  per  set ;  Half  Calf,  f  2-t  25. 

REBER'S  MEDIEVAL  ART.  History  of  Medieval  Art.  By 
Dr.  Franz  von  Reber.  Translated  and  Augmented  by  Joseph 
Thacher  Clarke.  With  422  Illustrations,  and  a  Glossary  of 
Technical  Terms.     8vo,  Cloth,  fS  00. 

REBER'S  HISTORY  OF  ANCIENT  ART.  History  of  Ancient 
Art.  By  Dr.  Franz  von  Reber.  Revised  by  ihe  Author. 
Translated  and  Augmented  by  Jose]ih  Thacher  Clarke.  With 
310  Illustrations  and  a  Glossary  of  Teclinical  Terms.  8vo, 
Cloth,  .$3  50. 

NEWCOMB'S  ASTRONOMY.  Popular  Astronomy.  By  Simon 
Newcomh,  LL.D.  With  112  Engravings,  and  5  Maps  of  the 
Stars.     8vo,  Cloth,  $2  50  ;  School  Edition,  12mo,  Cloth,  $1  30. 

DAVIS'S  INTERNATIONAL  LAW.  Outlines  of  International 
Law,  with  an  Account  of  its  Origin  and  Sources,  and  of  its  His- 
torical Development.  By  Geo.  B.  Davis,  U.S.A.,  Assistant 
Professor  of  Law  at  the  United  States  Military  Academy.  Crown 
8vo,  Cloth,  $2  00. 

CESNOL A'S  CYPRUS.  Cyprus :  its  Ancient  Cities,  Tombs,  and 
Temples.  A  Narrative  of  Researches  and  Excavations  during 
Ten  Years'  Residence  in  tliat  Island.  By  L.  P.  di  Cesnola. 
With  Portrait,  Maps,  and  400  Illustrations.  8vo,  Cloth,  Extra, 
Uncut  Edges  and  Gilt  Tops,  $7  50. 

TENNYSON'S  COMPLETE  POEMS.  The  Comi)lctc  Poetical 
Works  of  Alfred,  Lord  Tennyson.  With  an  Introductory  Sketch 
by  Anne  Thackerav  Ritchie.  With  Portraits  and  Illustrations. 
8vo,  Extra  Cloth,  :6evellcd.  Gilt  Edges,  $2  50. 

LEA'S  HISTORY  OF  THE  INQUISITION.  History  of  the  In- 
quisition of  the  Middle  Ages.  By  Henry  Charles  Lea.  Three 
Volumes.    8vo,  Cloth,  Uncut  Edges  and  Gilt  Tops,  ^S  00  per  vol. 

FLAMMARION'S  ATMOSPHERE.  Translated  from  the  French 
of  Camille  Flammarion.  With  10  Chromo-Lithographs  and 
8G  Wood-cuts.     8vo,  Cloth,  %G  00  ;   Half  Calf,  $8  25. 


COLUMBIA  UNIVERSITY 

This  book  is  due  on  the  date  indicated  below,  or  at  the 
expiration  of  a  definite  period  after  the  date  of  borrowing, 
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rangement with  the  Librarian  in  charge. 

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